title: Cardiovascular effects of dexmedetomidine sedation in children.
abstract: BACKGROUND
  Dexmedetomidine (DEX) affects heart rate (HR), mean arterial blood pressure, cardiac index (CI), stroke index (SI), and systemic vascular resistance index (SVRI) in adults. In this study we sought to determine whether similar effects occur in children undergoing DEX sedation.
  
  
  METHODS
  Hemodynamic changes in children were followed during IV DEX sedation for radiological procedures. One group of 8 patients (DEX-brief) received a bolus (2 mcg/kg bolus over 10 minutes) and completed the procedure within 10 minutes. The second group of 9 patients (DEX-prolong) received the bolus plus additional DEX as needed to maintain sedation for procedures lasting longer than 10 minutes (additional 1 mcg/kg/hr infusion with second bolus if needed). CI, SI, and SVRI were measured using a continuous noninvasive cardiac output monitor. Changes in hemodynamic variables at minutes 10, 20, and discharge (time at which patient achieved Aldrete Score ≥9) were compared to baseline by repeated measures ANOVA with effect sizes reported as mean [95% confidence interval].
  
  
  RESULTS
  Data were obtained during 8 DEX-brief and 9 DEX-prolong procedures. In DEX-brief, HR and CI decreased (18.9 [2.3 to 35.5] bpm and 0.74 [0.15 to 1.33] L/min/m(2); respectively) at T1. There was no change in any other hemodynamic variables and all hemodynamic variables returned to baseline at recovery. In DEX-prolong, both HR and CI remained decreased (24.0 [8.3 to 39.6] bpm, 1.51 [0.95 to 2.06] L/min/m(2); respectively) at recovery. In addition, SI was decreased (8.01 [1.71 to 14.31] mL/m(2)) and SVRI was increased (776.0 [271.9 to 1280.4] dynes-sec/cm(5)/m(2)) at recovery in the DEX-prolong group. There were no significant changes in mean arterial blood pressure in either group.
  
  
  CONCLUSIONS
  DEX decreases CI in children and has a cumulative effect. For patients undergoing prolonged procedures HR and CI remained decreased at the time of discharge together with a decrease in SI and an increase in SVRI.
authors.affiliation: Department of Medicine, Medicine Critical Care Program, Children's Hospital Boston and Harvard Medical School, MA, USA. Jackson.Wong@childrens.harvard.ed
authors.forename: Jackson
authors.initials: J
authors.lastname: Wong
authors.forename: Garry M
authors.initials: GM
authors.lastname: Steil
authors.forename: Michelle
authors.initials: M
authors.lastname: Curtis
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papas
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Keira P
authors.initials: KP
authors.lastname: Mason
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D001900:Boston; D002302:Cardiac Output / Q000187:drug effects; D002319:Cardiovascular System / Q000187:drug effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D004867:Equipment Design; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation; D011446:Prospective Studies; D013997:Time Factors; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine