• Yang Liu, Qing Yu, Mang Sun, Shangyingying Li, Jing Zhang, Yao Lei, Chaofeng Li, Fei Yang, and Shengfen Tu.
• From the Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders (YL, QY, MS, SL, JZ, YL, CL, FY, ST), China International Science and Technology Cooperation base of Child development and Critical Disorders (YL, QY, MS, JZ) and Chongqing Key Laboratory of Pediatrics, Chongqing, China (YL, QY, MS, JZ).
• Eur J Anaesthesiol. 2018 Jan 1; 35 (1): 43-48.

BackgroundDexmedetomidine (DEX) has been used for sedation in young infants and children undergoing transthoracic echocardiography (TTE). The median effective dose of intranasal DEX has not been described for postcardiac surgery children. Postcardiac surgery children could require more DEX to achieve satisfactory sedation for TTE examination than children suspected of congenital heart disease.ObjectivesTo study whether postcardiac surgery children need a larger dose of DEX for TTE than normal children.DesignA double-blind sequential allocation trial with doses determined by the Dixon and Massey up-and-down method.SettingA tertiary care teaching hospital from 25 October to 30 November 2016.PatientsChildren under the age of 3 years requiring intranasal DEX for TTE.InterventionsChildren were allocated to a postcardiac surgery group (n = 20) or a normal group (n = 19). The first patient in both groups received intranasal DEX (2 μg kg): using the up-and-down method of Dixon and Massey, the next dose was dependent on the previous patient's response.Main Outcome MeasuresMedian effective dose was estimated from the up-and-down method of Dixon and Massey and probit regression. A second objective was to study haemodynamic stability and adverse events with these doses.ResultsThe median effective dose (95% confidence interval) of intranasal DEX was higher in postcardiac surgery children than in normal children, 3.3 (2.72 to 3.78) μg kg versus 1.8 (1.71 to 2.04) (μg kg), respectively (P < 0.05). There were no significant differences in time to sedation, time to wake-up or TTE examination time between the two groups for successful sedation. Additionally, there were no significant adverse events.ConclusionThe median effective dose of intranasal DEX for TTE sedation in postcardiac surgery children was higher than in normal children.Trial Registrationchictr.org.cn identifier: ChiCTR-OOC-16009846.

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