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Efficacy of different doses of dexmedetomidine as a rapid bolus for children: a double-blind, prospective, randomized
Fang Chen1,2, Chengyu Wang2, Yi Lu2
1Department of Pain Management, Shandong Provincial Hospital affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, China.
Insights
Rapid bolus administration of dexmedetomidine (DEX) effectively prevents and treats emergence agitation (EA) in children. Higher doses of DEX reduced EA incidence with transient decreases in heart rate and blood pressure, showing good tolerance.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Dexmedetomidine (DEX) is an alpha2-adrenoceptor agonist with sedative, anxiolytic, and analgesic properties.
- DEX is recognized for preventing and treating emergence agitation (EA) in pediatric patients.
- Standard administration involves a 10-minute infusion, but rapid bolus injection may be a suitable alternative.
Purpose of the Study:
- To evaluate the efficacy of different doses of DEX administered as a rapid intravenous bolus for the prevention and treatment of EA in children.
- To compare the effects of various DEX dosages on hemodynamic parameters and recovery profiles.
Main Methods:
- A randomized controlled trial involving 100 pediatric patients divided into five groups: control and four DEX dosage groups (0.25, 0.5, 0.75, 1.0 μg/kg).
- Hemodynamic parameters (heart rate, mean blood pressure, oxygen saturation) were monitored closely post-injection.
- Incidence of EA, pain, and adverse events were assessed in the post-anesthesia care unit.
Main Results:
- Groups receiving 0.75 μg/kg (D4) and 1.0 μg/kg (D5) of DEX showed a significantly lower incidence of EA compared to the control group (D1).
- All DEX groups experienced significant decreases in heart rate and mean blood pressure compared to the control group.
- Higher DEX doses led to a prolonged duration of minimal heart rate, but no interventions were required; recovery time also increased with dosage.
Conclusions:
- Rapid IV bolus administration of 0.75 and 1.0 μg/kg DEX is effective in reducing EA incidence in children.
- Despite transient decreases in heart rate and blood pressure, DEX was well-tolerated, suggesting it is a viable option for EA management.
Background:
Dexmedetomidine (DEX), a highly sensitive α2-adrenoceptor agonist that possesses anxiolytic, sedative, and analgesic effects, has been documented as a preventative and treatment for emergence agitation (EA). The therapeutic should be given as a loading dose that is infused during a 10 min period, but if a rapid bolus injection is deemed to be hemodynamically appropriate, it would be a more opportune route of administration. So we studied the efficacy of different doses of DEX as a rapid bolus for children to prevent and treat EA.
Methods:
One hundred patients were enrolled and randomly divided into five groups: the control group (group D1), the 0.25 μg/kg DEX group (group D2), the 0.5 μg/kg DEX group (group D3), the 0.75 μg/kg DEX group (group D4), and the 1 μg/kg DEX group (group D5). Heart rate (HR), mean blood pressure (MBP) and blood oxygen saturation (SaO2) were recorded immediately before the study drug injection (baseline) and every minute for 5 min thereafter and at the time points of the skin cut and hernial sac pull. EA and pain were assessed in the post -anesthesia care unit, and any complementary medicine and adverse events were recorded too.
Results:
The incidence of EA was significantly decreased in group D4 and group D5 compared with D1.All groups exhibited similar baseline HR and MBP. After administered, HR and MBP were significantly decreased in all DEX group compared with group D1.In groups D3, D4 and D5, the minimal HR was decreased significantly compared with the groups D1 and duration time of minimal HR significantly prolonged in group D5, but no patient needed treatment. As the dosage increased, the recovery time was significantly prolonged. There were no significant differences in occurrence time of minimal HR, the incidence of complementary medicine and adverse events among groups.
Conclusion:
Rapid intravenous injection (IV) bolus administration of 0.75 and 1.0 μg/kg of DEX could improve the recovery profile by reducing the incidence of EA in children. Although its use resulted in a transient decreases in HR and MBP, DEX was clinically well-tolerated in children.
Trial Registration:
No. ChiCTR-IPR-17010658 . Registered 17 February 2017.
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