"Pediatric Sedation": Nasal Spray Cuts Side Effects by 80%

Nasal spray method cuts side effect rate from 16.7% to 3.2%
Combining CO2 concentration monitoring halves the risk of hypoxia

A study has found that replacing oral medication with a nasal spray method for pediatric sedation, used to help children fall asleep for hospital tests or procedures, can reduce side effects by as much as 80%.

The research team led by Professor Kim Jintae of the Department of Anesthesiology and Pain Medicine at Seoul National University Hospital announced on February 19 that they had demonstrated the safety of a new pediatric sedation strategy through a randomized clinical trial involving 128 children under the age of 7.

Pediatric sedation is a field where ensuring safety has been a major challenge, because if a child wakes up and moves during an examination, the procedure must be stopped and sedation reattempted. Until now, an oral drug called chloral hydrate has mainly been used, but this method often leads children to refuse the medication or induces vomiting, and if sedation fails, the risk of complications is considered high.

As an alternative, the researchers proposed intranasal spraying (nasal administration) of a mixed solution of dexmedetomidine and ketamine. In the clinical trial, the nasal spray method produced a sedative effect comparable to that of oral administration, while reducing the incidence of side effects such as apnea, decreased oxygen saturation, and vomiting from 16.7% to 3.2%.

The team also emphasized the importance of patient monitoring, not only the route of drug administration. Previously, clinicians relied on oxygen saturation monitoring, which measures the concentration of oxygen in the blood, but this has limitations because there is a time lag that makes it difficult to detect respiratory abnormalities in real time. To address this, the researchers additionally used end-tidal carbon dioxide (ETCO₂) monitoring, which measures the concentration of carbon dioxide in exhaled air, in 197 pediatric and adolescent patients under 18 years of age. As a result, they were able to recognize dangerous situations earlier and reduce the incidence of hypoxia from 32.7% to 15.6%, roughly cutting it in half.

This study was conducted with support from the Patient-Centered Clinical Research Coordinating Center (PACEN).

The research team stated, "By replacing oral administration with a nasal spray method and combining carbon dioxide monitoring with oxygen saturation monitoring, we clinically confirmed that it is possible to maintain the sedative effect while improving safety," and added, "To ensure widespread adoption in clinical practice, it will be necessary to broaden the range of diseases and symptoms for which these drugs can be used and to establish institutional foundations such as insurance coverage."

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