Intranasal dexmedetomidine for procedural sedation in preschool children aged 2-6 years undergoing emergency gastric lavage for acute poisoning: a propensity score-matched single-center retrospective cohort study.

Abstract

Objective This study aimed to evaluate the sedative efficacy and peri-procedural safety of preemptive intranasal dexmedetomidine in preschool children receiving emergency gastric lavage due to acute poisoning. Satisfactory procedural compliance rate was predefined as the primary efficacy outcome, and the total incidence of sedation-related adverse events was set as the primary safety outcome. Other behavioral scores, procedure time, vital signs and individual adverse reactions were regarded as secondary exploratory outcomes, and Bonferroni correction was used to correct multiple test bias for secondary indicators. We further quantified its benefits in enhancing procedural compliance, stabilizing peri-procedural vital signs, shortening rescue duration, and optimizing emergency staffing allocation-key practical challenges in overcrowded pediatric emergency departments. Methods We conducted a retrospective cohort study of 200 children undergoing emergency gastric lavage for acute poisoning. After propensity score matching (1:1), 100 children received intranasal dexmedetomidine (2 μg/kg) 10 min before the procedure combined with routine comfort care (observation group), and 100 received comfort care and physical restraint only (control group). Procedural compliance, agitation, hemodynamic and respiratory parameters, procedural efficiency, and adverse events were compared between the two groups. Procedural compliance rate served as the predefined primary efficacy outcome, while total adverse event incidence was the primary safety outcome; all remaining indicators were secondary exploratory outcomes adjusted via Bonferroni correction. Results Baseline characteristics were well balanced after matching. The observation group had a significantly higher effective compliance rate (93.0% vs. 60.0%) and first-attempt orogastric tube placement success rate (93.0% vs. 64.0%), and a lower agitation rate (7.0% vs. 40.0%) (all P < 0.001). Intraoperative heart rate, respiratory rate, and mean arterial pressure were significantly more stable and remained within normal physiological ranges in the observation group. This sedation protocol shortened lavage duration by 8.90 min, reduced orogastric tube placement attempts and staffing requirement (2.76-1.82 staff per case) (all P < 0.001), greatly improving rescue efficiency. No serious adverse events were observed in this selected cohort in either group, and all mild events resolved spontaneously. Conclusion Preemptive intranasal dexmedetomidine may serve as a safe, non-invasive sedative alternative for emergency gastric lavage among selected young children with acute poisoning. In this cohort, it was associated with improved procedural compliance and more stable peri-procedural vital signs. This regimen was also associated with shortened procedural duration and optimized emergency staffing resources, which may be valuable in overcrowded pediatric emergency departments. Observations of rapid onset, favorable tolerability and low frequency of respiratory-related events in the present cohort warrant further investigation in larger pediatric emergency populations.