Dexmedetomidine Dosing to Prevent Pediatric Emergence Delirium

Because of the high incidence and untoward effects of emergence delirium in the pediatric population, investigating pharmacologic measures for preventing this phenomenon is important to the anesthesia provider. Dexmedetomidine, a highly selective α₂ agonist, has been shown to prevent emergence delirium in the perioperative setting; however, recommendations for best practice regarding use of this medication are not widely available. Barriers to the use of dexmedetomidine may include side effects such as bradycardia and delayed emergence, as well as limited evidence for the best practice of timing, method, and dosing of dexmedetomidine. This review of the evidence included 2,142 study participants ranging in age from 1 to 15 years. The findings suggest that administering an intravenous bolus dose of 0.5 µg/kg of body weight in the intraoperative phase demonstrated a significant reduction in the incidence of emergence delirium with minimal side effects. Administration of dexmedetomidine immediately following induction of anesthesia revealed benefit in these patients without a delay in emergence from anesthesia. Along with the benefit of preventing emergence delirium in pediatric patients, the evidence also suggests that dexmedetomidine may lower volatile-agent and analgesic requirements.