Evaluating the safety and efficacy of rapid bolus-only dexmedetomidine for pediatric EEG sedation: a retrospective study.

Dexmedetomidine is an α2-adrenergic receptor agonist known for its sedative and analgesic properties. It produces an EEG pattern resembling Stage II sleep without interfering with EEG interpretation, making it a preferred agent for pediatric sedation, particularly during EEG procedures. Traditionally administered as a bolus followed by continuous infusion, this approach can challenge workflow efficiency and staffing in resource-limited settings. This study aimed to evaluate the safety and efficacy of a rapid bolus-only dexmedetomidine protocol for pediatric EEG sedation. This retrospective study included pediatric patients aged 1-18 years undergoing EEG with sedation at the Hadassah Medical Center between 2015 and 2023. All patients received dexmedetomidine via intravenous bolus (1-2 mcg/kg), with additional doses (0.5-2 mcg/kg) as needed. No continuous infusion was used. Primary outcomes were sedation success rate, time to onset and recovery, and adverse events. A total of 345 patients were included. Sedation was successfully achieved in 99% of cases, with a median sedation onset of 5 min. The overall adverse event rate was 8.4%, with no sentinel events. Hypotension and hypoxia occurred in 1.7% of patients each. Patients with upper airway abnormalities were more likely to require additional doses (P = 0.001) and showed a trend toward increased adverse events (P = 0.095). Adverse event risk increased with higher total dexmedetomidine doses (≥ 3 mcg/kg, P = 0.001).  Conclusion: Rapid bolus administration of dexmedetomidine without continuous infusion provides effective sedation for pediatric EEG, with a good safety profile, similar to other sedation protocols. This cost-effective approach offers significant advantages for settings with limited staffing or high patient turnover. What is Known: • Dexmedetomidine is well known as an effective agent for EEG procedural sedation. What is New: • We present a novel IV single bolus protocol utilizing dexmedetomidine that demonstrates a high success rate in achieving adequate sedation, is associated with a low incidence of adverse events, and requires an overall lower dosage compared to traditional methods.