title: Successful use of intravenous dexmedetomidine for magnetic resonance imaging sedation in autistic children.
abstract: OBJECTIVE
  Autism and autism spectrum disorders (A/ASD) represent a family of neurodevelopmental conditions that are associated with overactive, difficult-to-control behaviors. Sedating these patients for magnetic resonance imaging (MRI) poses challenges. Children with A/ASD were examined against clinical controls to determine the effectiveness and safety of intravenous (IV) dexmedetomidine for deep sedation.
  
  
  METHODS
  The quality assurance data on all of the children who received IV dexmedetomidine sedation for MRI between July 2007 and December 2012 were reviewed. Patients in both groups were sedated by an intensivist-based team with a standard plan of 2 μg/kg IV dexmedetomidine administered for 10 minutes followed by an infusion of 1 μg · kg(-1)· hour(-1). The amount of IV dexmedetomidine was titrated to the deep level of sedation. A total of 56 patients in the A/ASD group and 107 in the control group were sedated with no reported sedation failures. Sedation parameters were compared between the A/ASD and control groups using analysis of covariance models, controlling for age, sex, and weight.
  
  
  RESULTS
  Children in the A/ASD group were predominantly male (73%) and older (6.1 ± 0.3 years) than children in the control group (56%; 5.0 ± 0.2 years; P < 0.05 for both). Procedure time was significantly shorter for patients in the A/ASD group than in control patients (34.6 ± 2.4 vs 44.3 ± 1.6 minutes; P < 0.05). The A/ASD and control groups required a similar IV bolus of dexmedetomidine (2.6 μg/kg ± 0.1 vs 2.4 μg/kg ± 0.10; P = 0.29), with a significantly lower infusion dose in the A/ASD group (0.74 μg/kg ± 0.05 vs 0.89 μg/kg ± 0.03; P < 0.05). Heart rates were similar in the A/ASD group and the control group (67.0 beats per minute ± 1.6 vs 69.3 ± 1.1 beats per minute; P = 0.250). There were no complications. Recovery time was approximately 7 minutes longer in the A/ASD group than in the control group, but this was nonsignificant (101.2 ± 3.5 minutes vs 94.2 ± 2.4 minutes; P = 0.12). Analyses were performed using analysis of covariance methods and generalized linear models to control for age, sex, and weight.
  
  
  CONCLUSIONS
  Children with A/ASD can be successfully sedated for MRIs with IV dexmedetomidine without complications.
authors.affiliation: From the Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, and the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Sheikh Sohail
authors.initials: SS
authors.lastname: Ahmed
authors.affiliation: From the Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, and the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Tamara
authors.initials: T
authors.lastname: Unland
authors.affiliation: From the Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, and the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: James E
authors.initials: JE
authors.lastname: Slaven
authors.affiliation: From the Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, and the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Mara E
authors.initials: ME
authors.lastname: Nitu
authors.affiliation: From the Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, and the Department of Biostatistics, Indiana University School of Medicine, Indianapolis.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Rigby
mesh_terms: D061605:Administration, Intravenous; D001321:Autistic Disorder / Q000503:physiopathology / Q000523:psychology*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine