• Jing Zhang, Qing Yu, Yang Liu, Hui Liu, Mang Sun, Qin Tian, and Shengfen Tu.
• Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
• Nan Fang Yi Ke Da Xue Xue Bao. 2020 Jun 30; 40 (6): 864-868.

ObjectiveTo compare the median effective dose (ED50) of intranasal dexmedetomidine for procedural sedation in uncooperative pediatric patients with acyanotic congenital heart disease before and after cardiac surgery.MethodsWe prospectively recruited 47 children (22 in preoperative group and 25 in postoperative group) who needed sedation for transthoracic echocardiography (TTE). A modified up-and-down sequential study design was employed to determine dexmedetomidine dose for each patient with a starting dose of 2 μg/kg in both groups; dexmedetomidine doses for subsequent subjects were determined according to the responses from the previous subject using the up-and-down method at a 0.25 μg/kg interval. The ED95 was determined using probit regression. The onset time, examination time, wake-up time and adverse effects were measured, and the safety was evaluated in terms of changes in vital signs every 5 min.ResultsThe ED50 value of intranasal dexmedetomidine for sedation was 1.84 μg/kg (95% CI: 1.68-2.00 μg/kg) in children with congenital heart disease before cardiac surgery, and 3.38 μg/kg (95% CI: 3.21-3.54 μg/kg) after the surgery. No significant difference was found between the two groups in the demographic variables, onset time, examination time, wake-up time, or adverse effects.ConclusionsIn children with acyanotic congenital heart disease, the ED50 of intranasal dexmedetomidine for TTE sedation increases to 3.38 μg/ kg after cardiac surgery from the preoperative value of 1.84 μg/kg.

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