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Prolonged dexmedetomidine infusions in critically ill infants and children

Pamela D Reiter1, Molli Pietras, Emily L Dobyns

  • 1Department of Pharmacy, Center for Pediatric Medicine, The Children's Hospital, 13123 East 16th Ave, Denver, USA. reiter.pam@tchden.org

Indian Pediatrics
|May 12, 2009
PubMed

Insights

Prolonged infusions of dexmedetomidine (DEX) in critically ill children reduced the need for other sedatives and analgesics. DEX was generally well tolerated, with a slight decrease in heart rate upon initiation.

Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Intensive Care Unit Management

Background:

  • Prolonged sedation and analgesia are common in critically ill pediatric patients.
  • Dexmedetomidine (DEX) is an alpha-2 adrenergic agonist used for sedation and analgesia.
  • Limited data exist on the long-term use of DEX in pediatric intensive care settings.

Purpose of the Study:

  • To evaluate the institutional experience with prolonged dexmedetomidine (DEX) infusions in critically ill infants and children.
  • To assess the efficacy and tolerability of DEX in this population.

Main Methods:

  • Retrospective chart review of pediatric patients (up to 18 years) receiving DEX infusions for over 24 hours.
  • Data collected included DEX dosing, rationale for use, sedation scores, vital signs, and conventional analgesic/sedative requirements.
  • Analysis focused on changes in sedation scores, heart rate, blood pressure, and concomitant medication use.

Main Results:

  • Twenty-nine patients received DEX for a median of 76 hours (range 32-378 hours).
  • Common reasons for DEX use included facilitating extubation and reducing opioid/benzodiazepine use.
  • Sedation scores remained stable, and conventional analgesic/sedative use decreased.
  • A transient, statistically significant reduction in heart rate was observed upon initiation, but blood pressure remained unchanged.

Conclusions:

  • Prolonged dexmedetomidine infusions are effective in reducing the need for other sedatives and analgesics in critically ill children.
  • DEX was generally well tolerated, with a manageable decrease in heart rate.
  • Further research may clarify the clinical significance of heart rate changes with prolonged DEX use.
Abstract

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