The use of dexmedetomidine to facilitate acute discontinuation of opioids after cardiac transplantation in children.
OBJECTIVE
To report the use of dexmedetomidine to facilitate rapid opioid and benzodiazepine withdrawal in children with transplanted hearts and to review the receptor physiology and pharmacodynamic impact of dexmedetomidine on the denervated heart.


METHODS
Case series.


METHODS
Intensive care unit at a tertiary pediatric medical center.


METHODS
The series included a 6-month-old infant with pulmonary atresia who had a 3-month exposure to high-dose opioids and benzodiazepines and had undergone cardiac transplantation 4 wks before the use of dexmedetomidine and a 7-yr-old boy who had been sedated while undergoing extracorporeal membrane oxygenation for 3 wks before transplantation and started to receive dexmedetomidine 3 days after transplantation.


METHODS
Administration of dexmedetomidine to facilitate the discontinuation of opioids and benzodiazepine.


RESULTS
Successful rapid withdrawal from opioids and benzodiazepines while maintaining hemodynamic stability.


CONCLUSIONS
To our knowledge, this report describes the first use of dexmedetomidine to facilitate opioid withdrawal in children with a cardiac transplant. Dexmedetomidine allowed for the preservation of satisfactory hemodynamic parameters during acute withdrawal from opioids in children with denervated hearts.
Finkel
Julia C
JC
Department of Anesthesiology, Children's National Medical Center, George Washington University, Washington, DC, USA.
Johnson
Yewande J
YJ
Quezado
Zenaide M N
ZM
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000009:adverse effects*; D002648:Child; D020927:Dexmedetomidine / Q000627:therapeutic use*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009294:Narcotics / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*
D000316:Adrenergic alpha-Agonists; D009294:Narcotics; D001569:Benzodiazepines; D020927:Dexmedetomidine