Dexmedetomidine: pediatric pharmacology, clinical uses and safety.
BACKGROUND
Dexmedetomidine is an α(2)-adrenoceptor agonist with sedative, anxiolytic and analgesic properties. It is used off-label in pediatric patients due to its efficacy and lack of adverse respiratory effects. Dexmedetomidine may cause severe circulatory complications in adults. Despite its popularity, the safety of dexmedetomidine in the pediatric population has not been extensively studied.


METHODS
This article reviews the current literature (up to 2010) focusing on applications and safety of dexmedetomidine administered to pediatric patients.


RESULTS
Dexmedetomidine is a useful sedative and anxiolytic drug in the pediatric intensive care unit as well as during diagnostic and therapeutic procedures. Deleterious effects of dexmedetomidine include hypotension and bradycardia. Additionally, hypertension may occur during the "loading dose" or with high infusion rates. Few studies have been performed to evaluate the safety of dexmedetomidine in pediatrics. The development of tolerance and withdrawal has not been studied in children.


CONCLUSIONS
Despite its favorable respiratory profile, dexmedetomidine may cause deleterious cardiovascular effects. Close monitoring of circulatory dynamics and judicious titration is recommended. Further studies are needed to better define adverse effects following long-term infusions as well as in special populations such as pre-term infants.
Su
Felice
F
Division of Critical Care Medicine, Department of Pediatrics, Stanford University, 770 Welch Road, Palo Alto, CA 94304, USA. felicesu@stanford.edu
Hammer
Gregory B
GB
D058647:Adrenergic alpha-2 Receptor Agonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced; D002648:Child; D020927:Dexmedetomidine / Q000009:adverse effects* / Q000494:pharmacology* / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
D058647:Adrenergic alpha-2 Receptor Agonists; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine