Preparation & Dosing

This is example protocol content. All doses and preparation instructions must be reviewed and approved by the relevant clinical leads and pharmacy before use.

Drug Preparation

Intranasal dexmedetomidine requires a concentrated preparation to keep the administered volume small (ideally ≤0.5 mL per nostril, maximum 1 mL total). A large volume will drain into the pharynx and be swallowed rather than absorbed nasally.

Standard Preparation

Use the 200 mcg/2 mL (100 mcg/mL) formulation undiluted.

Do not dilute the preparation — a lower concentration will result in an unacceptably large volume for intranasal administration.

Prepare using an aseptic technique. Draw up the calculated dose into a 1 mL or 2 mL syringe. Attach the Mucosal Atomiser Device (MAD Nasal™) to the syringe immediately before administration.

Dose

Indication	Dose	Maximum
Premedication / anxiolysis	1–2 mcg/kg	100 mcg
Procedural sedation (e.g. wound care, cannulation)	1–2 mcg/kg	100 mcg
Imaging sedation (e.g. MRI)	2–3 mcg/kg	100 mcg

Use actual body weight for children within a normal weight range. For obese children, use ideal body weight.

Dose Calculation Example

Child weighing 20 kg requiring MRI sedation at 2 mcg/kg:
Dose = 20 × 2 = 40 mcg
Volume = 40 mcg ÷ 100 mcg/mL = 0.4 mL
Administer 0.2 mL into each nostril

Administration Technique

Position the child

Sit the child upright or at a 45° recline. A parent or carer holding the child in a comfortable position significantly improves cooperation.

Prepare the syringe

Draw up the calculated dose. Attach the MAD Nasal™ atomiser. Confirm the dose and patient details with a second practitioner.

Administer the first half

Insert the MAD tip into one nostril. Occlude the other nostril gently. Deliver half the calculated dose with a firm, brisk press of the plunger.

Administer the second half

Without removing the device, redirect to the other nostril and deliver the remaining half dose.

Monitor onset

Record time of administration. Onset is expected at 20–45 minutes. Keep the child in a safe, monitored environment. A parent or carer should remain present.

If the child cries or sneezes immediately after administration, some drug may be lost. Wait the full 45 minutes before concluding that sedation is inadequate — see Troubleshooting.

Timing

Indication	Administer
Pre-operative premedication	30–45 minutes before induction
Procedural sedation	30–45 minutes before procedure start
MRI sedation	45 minutes before scan start

Coordinate with the procedural team to avoid long waits in a sedated child.

Repeat Dosing

A single repeat dose of 1 mcg/kg (maximum 50 mcg) may be given if sedation is inadequate at 45 minutes and the clinical situation allows. This requires senior review. Do not repeat dose routinely.

Overview Monitoring