Safety and Effectiveness of Intramuscular Dexmedetomidine Versus Per-Rectal Thiopental for Pediatric Brain Computed Tomography Sedation
Jisun Shin, Seong Il Ryu, Dahyun Kim, Min Kyo Chun, Soo-young Lim, Jun Sung Park, Jeong-Yong Lee, Seung Jun Choi, Jong Seung Lee, Jeeho HanObjectives:
Following per-rectal thiopental (PR-THP) supply discontinuation, a tertiary pediatric emergency department in Korea transitioned to intramuscular dexmedetomidine (IM-DEX) for brain computed tomography (CT) sedation. We evaluated the safety and effectiveness of this protocol.
Methods:
We conducted a retrospective cohort study of alert children aged 1 month to 18 years undergoing brain CT sedation for traumatic head injury, comparing the PR-THP era (Jan 2024 to Mar 2025) with the IM-DEX era (May 2025 to Apr 2026). The primary outcome was safe CT completion: scan completion without a moderate-to-severe adverse event (respiratory event grade ≥2 or bradycardia requiring pharmacologic intervention). Secondary outcomes included rescue-free completion and sedation timeline metrics.
Results:
Among 246 completed sedation episodes (137 PR-THP, 109 IM-DEX), baseline characteristics were generally similar. Safe CT completion was 97.1% versus 99.1% (risk difference +2.0 percentage points, 95% CI: −1.3 to +5.3;
Conclusions:
IM-DEX served as a pragmatic, cannulation-free initial sedation strategy, with no clear excess in clinically significant adverse events and similar total sedation time. In alert children with traumatic head injury, IM-DEX may be a feasible sedation option when intravenous access is undesirable; findings should be applied with caution outside this population.