Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children.
OBJECTIVE
Children often require sedation for lengthy noninvasive procedures. Conventional agents such as chloral hydrate, benzodiazepines, or barbiturates have been associated with sedation failure, respiratory depression, and paradoxic agitation. Dexmedetomidine is a newer alpha(2)-adrenergic receptor agonist with sedative properties and minimal respiratory depression. We hypothesized that it would be an effective agent for these procedures.


METHODS
Prospective case series.


METHODS
Tertiary care children's hospital.


METHODS
Children undergoing noninvasive procedures.


METHODS
Children were sedated with dexmedetomidine given as a bolus of 0.5-1.0 microg/kg over 5-10 mins followed by an infusion of 0.5-1.0 microg/kg/hr. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded.


RESULTS
Forty-eight patients, aged 6.9 +/- 3.7 yrs, were sedated. Fifteen received dexmedetomidine after failing sedation with chloral hydrate and/or midazolam. Sedation was induced with 0.92 +/- 0.36 microg/kg over 10.3 +/- 4.7 mins and maintained with an infusion of 0.69 +/- 0.32 microg/kg/hr. All procedures were completed. Heart rate, blood pressure, and respiratory rate decreased (p < .0001) but remained within normal limits for age. End-tidal CO(2) exceeded 50 mm Hg in seven of 404 measurements (1.7%). Mean recovery time was 84 +/- 42 mins and was significantly longer in the rescue (117 +/- 41 mins) vs. primary (69 +/- 34 mins) group (p < .0001). No patient developed agitation during recovery.


CONCLUSIONS
Dexmedetomidine provided effective sedation in children undergoing noninvasive procedures and represents an alternative sedative choice for this population.
Berkenbosch
John W
JW
AssPediatrics/Pediatric Critical Care, University of Louisville, Kosair Children's Hospital, Louisville, KY, USA.
Wankum
Patricia C
PC
Tobias
Joseph D
JD
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine