Pediatric CT Sedation: Comparison of Dexmedetomidine and Pentobarbital

OBJECTIVE. Our institution replaced pentobarbital with dexmedetomidine for pediatric CT sedation. The purpose of this study was to compare the efficacy, incidence of adverse events, and cardiovascular and respiratory profiles of these two sedatives. MATERIALS AND METHODS. Quality assurance data were accessed for a review of demographics, outcome parameters, and adverse events among all children who received either pentobarbital or dexmedetomidine. RESULTS. From January 2004 through June 2009 there were 388 pentobarbital sedations and 1,274 dexmedetomidine sedations. Age, sex, weight, and duration of imaging study were similar in the two groups. Average time to achieve sedation was 12 +/- 4 minutes with dexmedetomidine and 6 +/- 3 minutes with pentobarbital (p < 0.001). Recovery time was 32 +/- 18 minutes with dexmedetomidine and 95 +/- 28 minutes with pentobarbital (p < 0.001). There were no differences between groups in incidence of oxygen desaturation and need for brief positive pressure ventilation. The odds of needing additional sedative agents to complete the study were significantly higher with pentobarbital than with dexmedetomidine (odds ratio, 4.0; 95% CI, 2.0-8.4; p < 0.001). There was a significantly lower incidence of agitation and rage with dexmedetomidine (p < 0.01) but higher risk of hypotension (p < 0.01). There was one failed sedation in each group (p = 0.99). CONCLUSION. Dexmedetomidine is a safe and effective alternative to pentobarbital for pediatric CT, being associated with a much shorter recovery time and less need for adjuvant sedatives.