The use of dexmedetomidine in critically ill children

Objective: To describe the use of dexmedetomidine for sedating intubated children in a general medical/surgical pediatric intensive care unit (PICU). Design: Retrospective, observational study. Setting: Multidisciplinary PICU of a tertiary, university-affiliated children’s hospital. Patients: All children receiving dexmedetomidine within the PICU during the period of August 2003 to August 2005. Interventions: None. Measurements and Main Results: During the study period, 121 mechanically ventilated patients, median age 36 months (range 2 months to 21 years), who received dexmedetomidine infusions. The infusion was initiated and adjusted per our PICU protocol. The average dose was 0.55 &mgr;g/kg/hr (range 0.15–0.70 &mgr;g/kg/hr) and average length of use was 25.8 hours (range 20 minutes to 60 hours). During the dexmedetomidine infusion, the mean decrease in total benzodiazepine and opiate dose as compared with the 24 hours prior was 42% and 36%, respectively. Most patients were able to reduce their benzodiazepine and opiate dose by at least 20% with the dexmedetomidine infusion (70% and 73% of patients, respectively). After discontinuing dexmedetomidine, the average change in total benzodiazepine and opiate dose as compared with the 24 hours before infusion was an increase of 14% and 1.5%, respectively. Fewer patients were able to maintain at least a 20% reduction in benzodiazepine and opiate after cessation of dexmedetomidine compared with the 24 hours before initiation (38% and 40% of patients, respectively). Hypotension and/or bradycardia requiring clinical intervention occurred in 33 of 121 (27%) patients. Discontinuation secondary to clinical concern was necessary in 12 of 121 (10%) patients. Conclusions: Our study suggests that many, although not all, mechanically ventilated children may be able to reduce their need for other sedation medications with the use of dexmedetomidine. However, the potential side effects of dexmedetomidine necessitates close hemodynamic monitoring with its use.

[1]  R. J. Ramamurthi,et al.  The use of dexmedetomidine during laryngoscopy, bronchoscopy, and tracheal extubation following tracheal reconstruction , 2007, Paediatric anaesthesia.

[2]  S. Stayer,et al.  Dexmedetomidine as an analgesic for pediatric tonsillectomy and adenoidectomy , 2007, Paediatric anaesthesia.

[3]  P. Joshi,et al.  Dexmedetomidine for pediatric MRI sedation: a review of a series of cases , 2007, Paediatric anaesthesia.

[4]  E. Capparelli,et al.  Pharmacokinetics of dexmedetomidine in postsurgical pediatric intensive care unit patients: Preliminary study* , 2007 .

[5]  D. Bandeira,et al.  Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children , 2007, Paediatric anaesthesia.

[6]  M. Kalyanaraman,et al.  Use of Dexmedetomidine in Patients with Trisomy 21 After Cardiac Surgery , 2007, Pediatric Cardiology.

[7]  J. Tobias,et al.  Hemodynamic and respiratory changes following dexmedetomidine administration during general anesthesia: sevoflurane vs desflurane , 2007, Paediatric anaesthesia.

[8]  K. Brady,et al.  Dexmedetomidine for the treatment of postanesthesia shivering in children , 2007, Paediatric anaesthesia.

[9]  J. Tobias.  Dexmedetomidine: Applications in pediatric critical care and pediatric anesthesiology , 2007, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[10]  J. Dasta,et al.  Dexmedetomidine: An Updated Review , 2007, The Annals of pharmacotherapy.

[11]  D. Nykanen,et al.  Initial experience with dexmedetomidine for diagnostic and interventional cardiac catheterization in children , 2007, Paediatric anaesthesia.

[12]  J. Lerman,et al.  A Phase I, Two-center Study of the Pharmacokinetics and Pharmacodynamics of Dexmedetomidine in Children , 2006, Anesthesiology.

[13]  A. Esmaoğlu,et al.  Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. , 2006, Journal of Cardiothoracic and Vascular Anesthesia.

[14]  D. Rosen,et al.  Short duration large dose dexmedetomidine in a pediatric patient during procedural sedation. , 2006, Anesthesia and analgesia.

[15]  Ahmet Koroglu,et al.  A Comparison of the Sedative, Hemodynamic, and Respiratory Effects of Dexmedetomidine and Propofol in Children Undergoing Magnetic Resonance Imaging , 2006, Anesthesia and analgesia.

[16]  J. Tobias.  Dexmedetomidine to treat opioid withdrawal in infants following prolonged sedation in the pediatric ICU. , 2006, Journal of opioid management.

[17]  D. Zurakowski,et al.  Dexmedetomidine for Pediatric Sedation for Computed Tomography Imaging Studies , 2006, Anesthesia and analgesia.

[18]  J. Tobias,et al.  Monitored anesthesia care with a combination of ketamine and dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea , 2006, Paediatric anaesthesia.

[19]  A. Mukhtar,et al.  Preliminary experience with dexmedetomidine in pediatric anesthesia. , 2006, Anesthesia and analgesia.

[20]  M. Arslan,et al.  Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery , 2006, Paediatric anaesthesia.

[21]  A. Mukhtar,et al.  The Use of Dexmedetomidine in Pediatric Cardiac Surgery , 2006, Anesthesia and analgesia.

[22]  R. Orr,et al.  Use of dexmedetomidine in children after cardiac and thoracic surgery* , 2006, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[23]  J. Ojemann,et al.  Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases , 2006, Paediatric anaesthesia.

[24]  C. Fischer,et al.  Sedation Using Dexmedetomidine in Pediatric Burn Patients , 2006, Journal of burn care & research : official publication of the American Burn Association.

[25]  U. Ramadhyani,et al.  Does dexmedetomidine prevent emergence delirium in children after sevoflurane‐based general anesthesia? , 2005, Paediatric anaesthesia.

[26]  S. Nicolson,et al.  THE PHARMACOKINETICS AND PHARMACODYNAMICS OF DEXMEDETOMIDINE IN INFANTS FOLLOWING OPEN HEART SURGERY.: 23 , 2005 .

[27]  E. Jooste,et al.  Fiberoptic intubation with dexmedetomidine in two children with spinal cord impingements. , 2005, Anesthesia and analgesia.

[28]  A. Esmaoğlu,et al.  Single‐dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy , 2005, Paediatric anaesthesia.

[29]  Z. Quezado,et al.  The use of dexmedetomidine to facilitate acute discontinuation of opioids after cardiac transplantation in children* , 2005, Critical care medicine.

[30]  C. Chrysostomou,et al.  Use of Dexmedetomidine in a Pediatric Heart Transplant Patient , 2005, Pediatric Cardiology.

[31]  E. T. Young.  Dexmedetomidine sedation in a pediatric cardiac patient scheduled for mri , 2005, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[32]  F. Rosen,et al.  Prolonged infusion of dexmedetomidine for sedation following tracheal resection , 2005, Paediatric anaesthesia.

[33]  J. Berkenbosch,et al.  Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[34]  A. But,et al.  Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. , 2005, British journal of anaesthesia.

[35]  U. Ramadhyani,et al.  Dexmedetomidine as the primary sedative agent for brain radiation therapy in a 21‐month old child , 2005, Paediatric anaesthesia.

[36]  J. Tobias,et al.  Dexmedetomidine in the Treatment of Withdrawal Syndromes in Cardiothoracic Surgery Patients , 2005, Journal of intensive care medicine.

[37]  J. Berkenbosch,et al.  Rescue sedation with dexmedetomidine for diagnostic imaging: a preliminary report , 2005, Paediatric anaesthesia.

[38]  C. Fahy,et al.  Sedation for Paediatric Stereotactic Radiosurgery: The Dexmedetomidine Experience , 2004, Anaesthesia and intensive care.

[39]  Ahmed Elrefai,et al.  The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant. , 2004, Anesthesia and analgesia.

[40]  S. Serlin.  Dexmedetomidine in pediatrics: controlled studies needed , 2004, Paediatric anaesthesia.

[41]  J. Berkenbosch,et al.  Sedation During Mechanical Ventilation in Infants and Children: Dexmedetomidine Versus Midazolam , 2004 .

[42]  H. Muñoz,et al.  Single-Dose Dexmedetomidine Reduces Agitation After Sevoflurane Anesthesia in Children , 2004, Anesthesia and analgesia.

[43]  J. Berkenbosch,et al.  Additional Experience with Dexmedetomidine in Pediatric Patients , 2003, Southern medical journal.

[44]  W. Doyle,et al.  Awake Craniotomy with Dexmedetomidine in Pediatric Patients , 2003, Journal of neurosurgical anesthesiology.

[45]  J. Berkenbosch,et al.  Preliminary experience with dexmedetomidine in the treatment of cyclic vomiting syndrome. , 2003, American journal of therapeutics.

[46]  Jun Lu,et al.  The &agr;2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects , 2003, Anesthesiology.

[47]  J. Berkenbosch,et al.  Initial experience with dexmedetomidine in paediatric‐aged patients , 2002, Paediatric anaesthesia.

[48]  J. Blumer,et al.  Assessing distress in pediatric intensive care environments: the COMFORT scale. , 1992, Journal of pediatric psychology.

[49]  J. Savola,et al.  Central alpha 2-adrenoceptors are highly stereoselective for dexmedetomidine, the dextro enantiomer of medetomidine. , 1991, European journal of pharmacology.

[50]  J. Savola,et al.  Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist. , 1988, European journal of pharmacology.