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Long-term dexmedetomidine use and safety profile among critically ill children and neonates
Lesta D Whalen1, Jane L Di Gennaro, Gretchen A Irby
1Department of Pediatric Critical Care, Seattle Children's Hospital, Seattle, WA.
Insights
Long-term dexmedetomidine use in pediatric ICUs did not increase opioid or benzodiazepine needs. However, patients experienced withdrawal symptoms like agitation and tremors upon discontinuation.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Intensive care
Background:
- Dexmedetomidine is used for sedation in pediatric intensive care units (PICUs).
- The safety and efficacy of long-term dexmedetomidine infusion, particularly regarding opioid/benzodiazepine sparing and withdrawal, require further investigation.
Purpose of the Study:
- To evaluate the association between long-term dexmedetomidine administration and opioid/benzodiazepine requirements.
- To assess hemodynamic stability and withdrawal symptoms following dexmedetomidine discontinuation in pediatric patients.
Main Methods:
- Retrospective, observational study of 98 pediatric patients (≤21 years) receiving dexmedetomidine for ≥72 hours.
- Data collected from cardiovascular ICU, neonatal ICU, and PICU at a tertiary care children's hospital.
- Analysis of hemodynamic parameters, opioid/benzodiazepine dosing, comfort scores, and withdrawal symptoms.
Main Results:
- Long-term dexmedetomidine use (median 141 hours) was not associated with increased opioid or benzodiazepine dosing.
- Dexmedetomidine initiation caused transient decreases in blood pressure and heart rate, which normalized upon discontinuation.
- Thirty percent of patients exhibited withdrawal symptoms (agitation, tremor, decreased sleep) after cessation.
Conclusions:
- Long-term dexmedetomidine is hemodynamically safe in diverse pediatric populations and does not necessitate increased opioid/benzodiazepine use.
- Improved patient comfort was observed during dexmedetomidine infusion.
- Withdrawal is a potential concern, necessitating careful monitoring and management.
Objective:
To determine whether long-term dexmedetomidine dosing is associated with lower opioid and benzodiazepine use without risk of significant hemodynamic changes and/or withdrawal.
Design:
Retrospective, observational study.
Setting:
PICU, cardiovascular ICU, and neonatal ICU in a single, tertiary care, academic children's hospital.
Subjects:
We included all patients less than or equal to 21 years old, who received dexmedetomidine for greater than or equal to 72 hours from December 2008 to December 2010 resulting in a 98-subject cohort.
Interventions:
None.
Measurement And Main Results:
The median duration of dexmedetomidine use was 141 hours. A decrease in systolic blood pressure and heart rate was seen after initiation of dexmedetomidine. After dexmedetomidine was discontinued, systolic blood pressure was statistically significantly higher than baseline. Similarly, heart rate showed a significant increase from baseline following discontinuation of dexmedetomidine. Starting dexmedetomidine was not associated with a significant difference in the dosing of opiates or benzodiazepines. Comfort scores were significantly lower at 2 and 72 hours of dexmedetomidine infusion. After stopping dexmedetomidine, the comfort score for patients at 1 hour was statistically higher than for patients at cessation of the infusion. Thirty percent of patients who were taken off dexmedetomidine, whether weaned or abruptly stopped, had withdrawal symptoms and scores recorded with agitation, tremor, and decreased sleep being most prominent.
Conclusions:
Hemodynamic effects of dexmedetomidine did not limit long-term use in this diverse population. After the addition of dexmedetomidine, opioid and benzodiazepine doses did not significantly escalate, and patients were more comfortable as evidenced by decreasing comfort scores. Withdrawal from dexmedetomidine may be an issue and manifests as agitation, tremors, and decreased sleep.
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