Prolonged dexmedetomidine infusions in critically ill infants and children.
OBJECTIVE
To present our institutional experience with prolonged dexmedetomidine (DEX) infusions in critically ill infants and children.


METHODS
Retrospective medical chart review between January 1, 2007 and December 1, 2007.


METHODS
Tertiary care pediatric teaching hospital.


METHODS
Infants and children (up to 18 years of age) who received DEX for a duration greater than 24 hours.


METHODS
DEX dosing schema and rationale for use. Indices describing DEX efficacy and tolerability including change in patient-specific sedation scores, change in blood pressure and heart rate, and change in conventional analgesia and sedation requirements.


RESULTS
Twenty-nine patients (age 5.32 +/- 6.1 y) were evaluated. DEX therapy was initiated at 0.36 +/- 0.16 mcg/kg/hour. One-third of patients received a loading dose (0.5-1 mcg/kg) prior to the start of the infusion. Duration of DEX therapy was 110 +/- 83 hours (range 32-378 hours; median 76 hours). Rationale for adding DEX to sedation regimens included: intent to extubate (n=12), intent to reduce benzodiazepine and opioid use (n=10), exclusive continuous sedation (n=5) and management of drug withdrawal (n=2). Sedation scores remained stable during DEX therapy. Use of conventional analgesia and sedation was generally reduced while receiving DEX. Initiation of therapy was associated with a transient, yet statistically significant reduction in HR (from 120 +/- 28 bpm to 107 +/-N 27 bpm) (P = 0.002), but without a change in blood pressure.


CONCLUSIONS
Prolonged DEX infusions were associated with a reduction in concomitant analgesia and sedation medications. DEX was well tolerated with the exception of heart rate, which decreased during the initiation of therapy but may not represent a clinically significant reduction.
Reiter
Pamela D
PD
Department of Pharmacy, Center for Pediatric Medicine, The Children's Hospital, 13123 East 16th Ave, Denver, USA. reiter.pam@tchden.org
Pietras
Molli
M
Dobyns
Emily L
EL
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D054810:Deep Sedation / 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; D007262:Infusions, Intravenous; D008297:Male; D012121:Respiration, Artificial; D012189:Retrospective Studies
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine