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High-dose dexmedetomidine-induced hypertension in a child with traumatic brain injury
Gwen Erkonen1, Fred Lamb, Joseph D Tobias
1Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
Insights
High-dose dexmedetomidine (a sedative) may cause hypertension in children. This case report shows that reducing the dexmedetomidine infusion rate resolved the hypertension, with no further issues.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Neurocritical Care
Background:
- Dexmedetomidine is an alpha(2)-adrenergic agonist FDA-approved for short-term adult sedation during mechanical ventilation.
- Increasing use in pediatric populations, with limited data on doses exceeding 0.7 microg/kg/h.
Observation:
- A 2-year-old child with traumatic brain injury received dexmedetomidine at 4 microg/kg/h.
- Hypertension developed during the infusion.
Findings:
- Investigation for other causes of hypertension was negative.
- Blood pressure normalized upon decreasing the dexmedetomidine infusion rate.
- No further hypertensive episodes occurred after dose adjustment.
Implications:
- Higher doses of dexmedetomidine may necessitate careful blood pressure monitoring in pediatric patients.
- Dose reduction is a viable strategy to manage dexmedetomidine-induced hypertension.
- Further research is needed on the safety and efficacy of high-dose dexmedetomidine in children.
Introduction:
Dexmedetomidine is a centrally acting alpha(2)-adrenergic agonist which is currently FDA-approved for the short-term (less than 24 h) sedation of adults during mechanical ventilation.
Discussion:
Given its beneficial physiologic properties, there has been increasing use of this agent in the pediatric population. As with any agent used for sedation in the Pediatric ICU setting, dose escalations may be necessary. Unlike benzodiazepines and opioids, there are limited data regarding the administration of dexmedetomidine above the current package insert dosing recommendations of 0.7 microg/kg/h.
Results:
We report a 2-year-old child with traumatic brain injury who developed hypertension following the administration of a dexmedetomidine infusion at 4 microg/kg/h for several hours. Investigation into the etiology of the hypertension was negative and the blood pressure returned to baseline with a decrease in the infusion rate.
Conclusion:
Subsequent to this, no further issues with hypertension were noted.
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