Farmacoriflessioni
Dexmedetomidina intranasale per sedazione procedurale
Intranasal dexmedetomidine for procedural sedation
Giorgio Cozzi1, Giuliana Morabito2, Giulia Caddeo3, Stefania Norbedo1, Natalia Maximova1, Federico Poropat1, Francesca Barbieri3, Davide Zanon1, Alessandra Maestro1, Laura Travan1, Stefano Furlan1, Egidio Barbi1
1IRCCS Materno-Infantile “Burlo Garofolo”, Trieste; 2Università degli Studi di Messina; 3Università degli Studi di Trieste
Dicembre 2016 - pagg. 641 -645
Abstract
Sedation outside the operating theatre for diagnostic and therapeutic procedures in children
is more and more frequently performed. Most of the sedative drugs commonly used in
this setting, such as midazolam, chloral hydrate and propofol, may induce respiratory depression
and apnoea. Dexmedetomidine is a high selective alpha2-adrenergic receptor agonist
that acts in the locus coeruleus and induces a natural state of non-rapid eye movement
sleep. Contrary to most of the other sedatives, it preserves respiratory drive. Moreover,
it neither causes respiratory depression nor influences the patency and tone of the airways.
Dexmedetomidine use in paediatrics has been extensively evaluated in clinical studies
in the intensive care unit setting. Recently, substantial evidence has showed its efficacy
and safety via the intranasal route outside the intensive care setting. Dexmedetomidine has
only a minor analgesic effect, so its use is ideal for non-painful diagnostic radiological or
instrumental procedures. The main adverse event reported with dexmedetomidine is a relative
haemodynamic variability, which only rarely needs a medical support. All these features
make dexmedetomidine use particularly interesting for non-painful procedures outside
the operating theatre. However, in Italy its use via the intranasal route is still off-label.
Classificazione MeSH
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Corrispondenza: giorgiocozzi@gmail.com