Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial
Summary Background Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single‐dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age o...
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| Veröffentlicht in: | Pediatric anesthesia 2017-11, Vol.27 (11), p.1108-1114 |
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| creator | Yu, Qing Liu, Yang Sun, Mang Zhang, Jing Zhao, Yan Liu, Fengzhi Li, Shangyingying Tu, Shengfen |
| description | Summary
Background
Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single‐dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial.
Objective
This study was to determine the 50% effective dose and estimate the 95% effective dose of single‐dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation.
Methods
Patients were stratified into three age groups of 1‐6 months, 7‐12 months, and 13‐36 months. Intranasal dexmedetomidine started at a dose of 2 μg kg−1 on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up‐and‐down method with an interval of 0.25 μg kg−1. Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up‐and‐down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake‐up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea.
Results
The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58‐2.00) μg kg−1 and 2.2 (1.92‐5.62) μg kg−1 in patients aged 1‐6 months, 1.8 (1.61‐1.95) μg kg−1 and 2.1 (1.90‐2.85) μg kg−1 in patients aged 7‐12 months, 2.2 (1.92‐2.37) μg kg−1 and 2.7 (2.34‐6.88) μg kg−1 in patients aged 13‐36 months, respectively. The 50% effective dose in age group 13‐36 months was higher than those of age group 1‐6 months (P = .042) and 7‐12 months (P = .043). There were no differences in sedation onset time, echocardiography time, wake‐up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred.
Conclusion
Single‐dose of intranasal dexmedetomidine was |
| doi_str_mv | 10.1111/pan.13235 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1942709369</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1942709369</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3535-14bd648459aba14b9ced44232684f7527c8579778f13708b44c212f61c2c2d8f3</originalsourceid><addsrcrecordid>eNp1kUuO1DAQhi0EYoaGBRdAltjAIjOxYycxu9aIlzQ8FrCO3HZ54lHaDrZD0zuOwM24AyehenpggYQXfqi--v-Sf0Ies_qM4TqfdThjDW_kHXLKRFtXSip-F-9Mykq2Qp6QBzlf1zVCLb9PTnivRN327Sn5-Q6s14GCc2CK_wrUxgw0OupDSTrorCdq4dsWLJS49dYHoBmsLj4G6mKiByqXMSZtvKFgxmh0sj5eJT2Pe5Sh88GiJKzO2AahZLrzZaQhBrPXIRasmBiuIPiCbiPoVKj1GXSGF3Qd6DL_-v5DB4u7jbuA_l8WlPEI62lCv5th0EFPD8k9p6cMj27PFfn86uWnizfV5YfXby_Wl5VpZCMrJja2Fb2QSm80PpQBKwTH7-mF6yTvTC871XW9Y01X9xshDGfctcxww23vmhV5dtSdU8Rhchm2PhuYJh0gLnlgSvCuVk2rEH36D3odlxRwOqRkLTuuMJgVeX6kTIo5J3DDnPxWp_3A6uGQ8oApDzcpI_vkVnHZYDB_yT-xInB-BHZ-gv3_lYaP6_dHyd-K87gM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1950572901</pqid></control><display><type>article</type><title>Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Yu, Qing ; Liu, Yang ; Sun, Mang ; Zhang, Jing ; Zhao, Yan ; Liu, Fengzhi ; Li, Shangyingying ; Tu, Shengfen</creator><creatorcontrib>Yu, Qing ; Liu, Yang ; Sun, Mang ; Zhang, Jing ; Zhao, Yan ; Liu, Fengzhi ; Li, Shangyingying ; Tu, Shengfen</creatorcontrib><description>Summary
Background
Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single‐dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial.
Objective
This study was to determine the 50% effective dose and estimate the 95% effective dose of single‐dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation.
Methods
Patients were stratified into three age groups of 1‐6 months, 7‐12 months, and 13‐36 months. Intranasal dexmedetomidine started at a dose of 2 μg kg−1 on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up‐and‐down method with an interval of 0.25 μg kg−1. Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up‐and‐down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake‐up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea.
Results
The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58‐2.00) μg kg−1 and 2.2 (1.92‐5.62) μg kg−1 in patients aged 1‐6 months, 1.8 (1.61‐1.95) μg kg−1 and 2.1 (1.90‐2.85) μg kg−1 in patients aged 7‐12 months, 2.2 (1.92‐2.37) μg kg−1 and 2.7 (2.34‐6.88) μg kg−1 in patients aged 13‐36 months, respectively. The 50% effective dose in age group 13‐36 months was higher than those of age group 1‐6 months (P = .042) and 7‐12 months (P = .043). There were no differences in sedation onset time, echocardiography time, wake‐up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred.
Conclusion
Single‐dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3 years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13‐36 months was higher than in children <13 months.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.13235</identifier><identifier>PMID: 28940686</identifier><language>eng</language><publisher>France: Wiley Subscription Services, Inc</publisher><subject>Administration, Intranasal ; Age ; Anesthesia ; Cardiovascular disease ; Child, Preschool ; Confidence intervals ; Congenital diseases ; dexmedetomidine ; Dexmedetomidine - administration & dosage ; Dexmedetomidine - therapeutic use ; Dose-Response Relationship, Drug ; Double-Blind Method ; Echocardiography ; Female ; Heart Defects, Congenital - diagnostic imaging ; Humans ; Hypnotics and Sedatives - administration & dosage ; Hypnotics and Sedatives - therapeutic use ; Infant ; Infant, Newborn ; intranasal administration ; Male ; median effective dose ; Patients ; Pediatrics ; sedation</subject><ispartof>Pediatric anesthesia, 2017-11, Vol.27 (11), p.1108-1114</ispartof><rights>2017 John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons Ltd.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-14bd648459aba14b9ced44232684f7527c8579778f13708b44c212f61c2c2d8f3</citedby><cites>FETCH-LOGICAL-c3535-14bd648459aba14b9ced44232684f7527c8579778f13708b44c212f61c2c2d8f3</cites><orcidid>0000-0001-9593-3978</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.13235$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.13235$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28940686$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yu, Qing</creatorcontrib><creatorcontrib>Liu, Yang</creatorcontrib><creatorcontrib>Sun, Mang</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Zhao, Yan</creatorcontrib><creatorcontrib>Liu, Fengzhi</creatorcontrib><creatorcontrib>Li, Shangyingying</creatorcontrib><creatorcontrib>Tu, Shengfen</creatorcontrib><title>Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>Summary
Background
Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single‐dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial.
Objective
This study was to determine the 50% effective dose and estimate the 95% effective dose of single‐dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation.
Methods
Patients were stratified into three age groups of 1‐6 months, 7‐12 months, and 13‐36 months. Intranasal dexmedetomidine started at a dose of 2 μg kg−1 on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up‐and‐down method with an interval of 0.25 μg kg−1. Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up‐and‐down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake‐up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea.
Results
The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58‐2.00) μg kg−1 and 2.2 (1.92‐5.62) μg kg−1 in patients aged 1‐6 months, 1.8 (1.61‐1.95) μg kg−1 and 2.1 (1.90‐2.85) μg kg−1 in patients aged 7‐12 months, 2.2 (1.92‐2.37) μg kg−1 and 2.7 (2.34‐6.88) μg kg−1 in patients aged 13‐36 months, respectively. The 50% effective dose in age group 13‐36 months was higher than those of age group 1‐6 months (P = .042) and 7‐12 months (P = .043). There were no differences in sedation onset time, echocardiography time, wake‐up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred.
Conclusion
Single‐dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3 years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13‐36 months was higher than in children <13 months.</description><subject>Administration, Intranasal</subject><subject>Age</subject><subject>Anesthesia</subject><subject>Cardiovascular disease</subject><subject>Child, Preschool</subject><subject>Confidence intervals</subject><subject>Congenital diseases</subject><subject>dexmedetomidine</subject><subject>Dexmedetomidine - administration & dosage</subject><subject>Dexmedetomidine - therapeutic use</subject><subject>Dose-Response Relationship, Drug</subject><subject>Double-Blind Method</subject><subject>Echocardiography</subject><subject>Female</subject><subject>Heart Defects, Congenital - diagnostic imaging</subject><subject>Humans</subject><subject>Hypnotics and Sedatives - administration & dosage</subject><subject>Hypnotics and Sedatives - therapeutic use</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>intranasal administration</subject><subject>Male</subject><subject>median effective dose</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>sedation</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUuO1DAQhi0EYoaGBRdAltjAIjOxYycxu9aIlzQ8FrCO3HZ54lHaDrZD0zuOwM24AyehenpggYQXfqi--v-Sf0Ies_qM4TqfdThjDW_kHXLKRFtXSip-F-9Mykq2Qp6QBzlf1zVCLb9PTnivRN327Sn5-Q6s14GCc2CK_wrUxgw0OupDSTrorCdq4dsWLJS49dYHoBmsLj4G6mKiByqXMSZtvKFgxmh0sj5eJT2Pe5Sh88GiJKzO2AahZLrzZaQhBrPXIRasmBiuIPiCbiPoVKj1GXSGF3Qd6DL_-v5DB4u7jbuA_l8WlPEI62lCv5th0EFPD8k9p6cMj27PFfn86uWnizfV5YfXby_Wl5VpZCMrJja2Fb2QSm80PpQBKwTH7-mF6yTvTC871XW9Y01X9xshDGfctcxww23vmhV5dtSdU8Rhchm2PhuYJh0gLnlgSvCuVk2rEH36D3odlxRwOqRkLTuuMJgVeX6kTIo5J3DDnPxWp_3A6uGQ8oApDzcpI_vkVnHZYDB_yT-xInB-BHZ-gv3_lYaP6_dHyd-K87gM</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Yu, Qing</creator><creator>Liu, Yang</creator><creator>Sun, Mang</creator><creator>Zhang, Jing</creator><creator>Zhao, Yan</creator><creator>Liu, Fengzhi</creator><creator>Li, Shangyingying</creator><creator>Tu, Shengfen</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9593-3978</orcidid></search><sort><creationdate>201711</creationdate><title>Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial</title><author>Yu, Qing ; Liu, Yang ; Sun, Mang ; Zhang, Jing ; Zhao, Yan ; Liu, Fengzhi ; Li, Shangyingying ; Tu, Shengfen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-14bd648459aba14b9ced44232684f7527c8579778f13708b44c212f61c2c2d8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Administration, Intranasal</topic><topic>Age</topic><topic>Anesthesia</topic><topic>Cardiovascular disease</topic><topic>Child, Preschool</topic><topic>Confidence intervals</topic><topic>Congenital diseases</topic><topic>dexmedetomidine</topic><topic>Dexmedetomidine - administration & dosage</topic><topic>Dexmedetomidine - therapeutic use</topic><topic>Dose-Response Relationship, Drug</topic><topic>Double-Blind Method</topic><topic>Echocardiography</topic><topic>Female</topic><topic>Heart Defects, Congenital - diagnostic imaging</topic><topic>Humans</topic><topic>Hypnotics and Sedatives - administration & dosage</topic><topic>Hypnotics and Sedatives - therapeutic use</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>intranasal administration</topic><topic>Male</topic><topic>median effective dose</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>sedation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yu, Qing</creatorcontrib><creatorcontrib>Liu, Yang</creatorcontrib><creatorcontrib>Sun, Mang</creatorcontrib><creatorcontrib>Zhang, Jing</creatorcontrib><creatorcontrib>Zhao, Yan</creatorcontrib><creatorcontrib>Liu, Fengzhi</creatorcontrib><creatorcontrib>Li, Shangyingying</creatorcontrib><creatorcontrib>Tu, Shengfen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yu, Qing</au><au>Liu, Yang</au><au>Sun, Mang</au><au>Zhang, Jing</au><au>Zhao, Yan</au><au>Liu, Fengzhi</au><au>Li, Shangyingying</au><au>Tu, Shengfen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2017-11</date><risdate>2017</risdate><volume>27</volume><issue>11</issue><spage>1108</spage><epage>1114</epage><pages>1108-1114</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>Summary
Background
Intranasal dexmedetomidine can provide adequate sedation during short procedures. However, previous literature investigating the single‐dose use of intranasal dexmedetomidine for sedation during transthoracic echocardiography in younger children is scarce, and the effects of age on sedation with intranasal dexmedetomidine remain controversial.
Objective
This study was to determine the 50% effective dose and estimate the 95% effective dose of single‐dose intranasal dexmedetomidine to induce sedation in pediatric patients with noncyanotic congenital heart disease, and also determine the effect of age on the dose required for sedation.
Methods
Patients were stratified into three age groups of 1‐6 months, 7‐12 months, and 13‐36 months. Intranasal dexmedetomidine started at a dose of 2 μg kg−1 on the first patient. The dose of dexmedetomidine for each subsequent patient was determined by the previous patient's response using Dixon's up‐and‐down method with an interval of 0.25 μg kg−1. Sedation scale and recovery were assessed by the Modified Observer Assessment of Alertness and Sedation Scale and Modified Aldrete Recovery Score. The 50% effective dose was determined by Dixon's up‐and‐down method. In addition, both 50% effective dose and 95% effective dose were obtained using a probit regression approach. Other variables included sedation onset time, echocardiography time, wake‐up time, discharge time, heart rate, blood pressure, oxygen saturation, respiratory rate, and adverse events such as vomiting, regurgitation, and apnea.
Results
The study population was comprised of 70 patients. The 50% effective dose (95% confidence interval) and the 95% effective dose (95% confidence interval) of intranasal dexmedetomidine for sedation were 1.8 (1.58‐2.00) μg kg−1 and 2.2 (1.92‐5.62) μg kg−1 in patients aged 1‐6 months, 1.8 (1.61‐1.95) μg kg−1 and 2.1 (1.90‐2.85) μg kg−1 in patients aged 7‐12 months, 2.2 (1.92‐2.37) μg kg−1 and 2.7 (2.34‐6.88) μg kg−1 in patients aged 13‐36 months, respectively. The 50% effective dose in age group 13‐36 months was higher than those of age group 1‐6 months (P = .042) and 7‐12 months (P = .043). There were no differences in sedation onset time, echocardiography time, wake‐up time, and discharge time between groups. None of the patients experienced oxyhemoglobin desaturation, hypotension, or bradycardia during the procedure. No significant adverse events occurred.
Conclusion
Single‐dose of intranasal dexmedetomidine was an effective agent for patients under the age of 3 years requiring sedation for transthoracic echocardiography. The 50% effective dose of intranasal dexmedetomidine for transthoracic echocardiography sedation in children aged 13‐36 months was higher than in children <13 months.</abstract><cop>France</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28940686</pmid><doi>10.1111/pan.13235</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-9593-3978</orcidid></addata></record> |
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| subjects | Administration, Intranasal Age Anesthesia Cardiovascular disease Child, Preschool Confidence intervals Congenital diseases dexmedetomidine Dexmedetomidine - administration & dosage Dexmedetomidine - therapeutic use Dose-Response Relationship, Drug Double-Blind Method Echocardiography Female Heart Defects, Congenital - diagnostic imaging Humans Hypnotics and Sedatives - administration & dosage Hypnotics and Sedatives - therapeutic use Infant Infant, Newborn intranasal administration Male median effective dose Patients Pediatrics sedation |
| title | Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial |
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