This won't hurt a bit ... a pain-free approach to sedation for kids

Every year, thousands of children around New Zealand are given sedative medicine to help them cope with necessary medical procedures. But giving sedative medicine via a needle or mask can be distressing for children – and their families. So, how can we ensure that kids who require sedation are not additionally stressed by how it is given? Maybe all they need is a sticking plaster...

Every year in New Zealand, more than 40,000 children are admitted to hospital. Many of these children will require procedures that are performed under sedation. 

Sedative medicine is given to children when a procedure is likely to be painful or distressing. It may also be given if a child is required to remain still during a procedure. Sedation makes a child feel sleepy and calm, reducing their awareness. It also provides a blanket of memory loss – meaning that the child is unlikely to remember later what happened during the procedure.

Dexmedetomidine is one of the most commonly used sedative medicines. In 2019, nearly 70% of anaesthetists in New Zealand and Australia reported using dexmedetomidine when sedating children. 

One of the drawbacks of using dexmedetomidine is that it must be given intravenously (into the vein using a needle) or intranasally (inhaled through a mask or tubes inserted into the nose). But for many children – and their families – the use of needles, masks, or tubing to deliver sedation is a distressing process. A potential solution to this problem might be found in microneedles.

Microneedles are tiny needles — usually attached to a sticky patch — that can deliver medications through the skin. Because microneedles are so small, they do not reach pain receptors deeper in the skin, meaning they are painless compared to traditional needles. 

“Microneedles are very small — as thin as human hair,” says Dr Manisha Sharma, Senior Lecturer at the University of Auckland, “and therefore offer benefits for children, being minimally invasive and painless. Besides being painless, microneedles involve a comparatively effortless application — like putting on Band-Aid or sticker — making it patient-friendly.”

Dr Sharma and her co-investigators — Dr Nicola Whittle, an Anaesthetist at Waikato Hospital, Dr Martyn Harvey, an Emergency Physician at Waikato Hospital, and Dr Brian Anderson, a Professor at the University of Auckland — plan to design and evaluate a dissolvable microneedle patch loaded with dexmedetomidine. 

They will first test the microneedle patch in small rat animal model – to make sure that the patch is safe and effective before it can be trialled in children. “Coming to hospital can be a stressful, anxiety-provoking experience for our tamariki and their whanau,” says Dr Sharma and her team. 

“Hospital staff do everything they can to alleviate the stress and pain, but often procedures are required, such as placing an intravenous cannula, which can be painful or scary for children and their caregivers. This project will enable a sedative to be delivered just by placing a sticker on the child’s skin.”

For the researchers, this project collaboration is ideal. “Working with distressed children and their families sparked a research interest in improving sedation in the emergency department and prior to surgery,” says Dr Sharma. 

“Dr Whittle then began investigating novel administration methods for dexmedetomidine ... and Professor Anderson contributed his internationally recognised research experience in the paediatric pharmacology of dexmedetomidine.” 

Dr Harvey, who brings extensive research experience in lab pharmacology, connected with Dr Sharma, who had the microneedle expertise to tie the project together.

“The way this team, with different expertise, came together to achieve a common specific goal was a significant moment,” says Dr Sharma. “We are convinced that the project will make a real difference in the future.”

This project was one of nine chosen to receive a Project Grant from Cure Kids in 2021. It is only through the generous contributions of people like you that Cure Kids can continue to fund vital research – such as the work of Dr Sharma and her team in improving sedation for children. 

Cure Kids is committed to enabling research that has the potential to transform the health and wellbeing of our precious tamariki – but we need your help. Find out how you can become a Cure Kids donor today.