• J W Miller, R Balyan, M Dong, M Mahmoud, J E Lam, J N Pratap, J R Paquin, B L Li, J P Spaeth, A Vinks, and A W Loepke.
• Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Jeff.Miller@cchmc.org.
• Br J Anaesth. 2018 May 1; 120 (5): 1056-1065.

BackgroundAtomised intranasal dexmedetomidine administration is an attractive option when sedation is required for paediatric diagnostic procedures, as vascular access is not required. The risk of haemodynamic instability caused by dexmedetomidine necessitates better understanding of its pharmacokinetics in young children. To date, intranasal dexmedetomidine pharmacokinetics has only been studied in adults.MethodsEighteen paediatric patients received dexmedetomidine 1 or 2 μg kg-1 intranasally or 1 μg kg-1 i.v. Plasma concentrations were determined by liquid chromatography/mass spectrometry. Non-compartmental analysis provided estimates of Cmax and Tmax. Volume of distribution, clearance, and bioavailability were estimated by simultaneous population PK analysis of data after intranasal and i.v. administration. Dexmedetomidine plasma concentration-time profiles were evaluated by simulation for intranasal and i.v. administration.ResultsAn average peak plasma concentration of 199 pg ml-1 was achieved 46 min after 1 μg kg-1 dosing and 355 pg ml-1 was achieved 47 min after 2 μg kg-1 dosing. A two-compartment pharmacokinetic model, with allometrically scaled parameters, adequately described the data. Typical bioavailability was 83.8% (95% confidence interval 69.5-98.1%).ConclusionMean arterial plasma concentrations of dexmedetomidine in infants and toddlers approached 100 pg ml-1, the low end reported for sedative efficacy, within 20 min of an atomised intranasal administration of 1 μg kg-1. Doubling the dose to 2 μg kg-1 reached this plasma concentration within 10 min and achieved almost twice the peak concentration. Peak plasma concentrations with both doses were reached within 47 min of intranasal administration, with an overall bioavailability of 84%.Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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