Prolonged use of dexmedetomidine in the paediatric cardiothoracic intensive care unit.
BACKGROUND
Dexmedetomidine is an alpha2-adrenergic agonist that causes sleep-like sedation and mild analgesia without narcosis or respiratory depression, and has relative cardiovascular stability. Due to these properties, it may be an effective agent for prolonged use in the sedation of patients in the paediatric cardiothoracic intensive care unit. We reviewed our experience with the drug to detail its safety and efficacy.


METHODS
We conducted a retrospective chart review of all patients who received dexmedetomidine over a six month period in a dedicated paediatric cardiothoracic intensive care unit. Patients were identified from pharmacy records showing administration of drugs. We collected demographic data, information relating to doses of dexmedetomidine, physiologic parameters, and clinical outcomes.


RESULTS
We identified 54 patients who received the drug. The median age of recipients was 6 months, with a range from 1 day to 16 years. The mean duration of administration was 37.3 hours, with a range from 2 to 177 hours. The mean duration of continuation of administration after extubation was 16.7 hours, with a range from zero to 112.5 hours. Physiologically, there were no clinically significant changes in mean arterial pressure, heart rate, respiratory rate, or saturations of oxygen before, during, or after utilization of the drug. Use of dexmedetomidine significantly reduced the need to administer narcotics, and scores using the COMFORT system were not different between patients who received dexmedetomidine and those who did not.


CONCLUSIONS
In this limited and retrospective review, dexmedetomidine was found to be safe and efficacious. Its use as a sedative agent for extended periods of time in critically-ill children deserves investigation in a prospective and controlled manner.
Bejian
Sharon
S
Eller Congenital Heart Center, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Phoenix, AZ 85013, USA.
Valasek
Cassie
C
Nigro
John J
JJ
Cleveland
David C
DC
Willis
Brigham C
BC
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine