title: Hemodynamic responses to dexmedetomidine in critically injured intubated pediatric burned patients: a preliminary study.
abstract: Because of ineffectiveness and tolerance to benzodiazepines and opioids developing with time, drugs acting via other receptor systems (eg, α-2 agonists) have been advocated in burn patients to improve sedation and analgesia. This study in severely burned pediatric subjects examined the hemodynamic consequences of dexmedetomidine (Dex) administration. Eight intubated patients with ≥20 to 79% TBSA burns were studied between 7 and 35 days after injury. After baseline measurements of mean arterial blood pressure and heart rhythm were taken, each patient received a 1.0 µg/kg bolus of Dex followed by an ascending dose infusion protocol (0.7-2.5 µg/kg/hr), with each dose administered for 15 minutes. There was significant hypotension (27±7.5%, average drop in mean arterial pressure [MAP] ± SD), and a decrease in heart rate (HR; 19% ± 7, average drop in HR ± SD). The average HR decreased from 146 beats per minute to 120. No bradycardia (HR < 60) or heart blocks were observed. In three patients, the MAP decreased to <50mm Hg with the bolus dose of Dex. Of the remaining five patients, three patients completed the study receiving the highest infusion dose of Dex (2.5 µg/kg/hr), whereas in 2 patients the infusion part of the study was begun, but the study was stopped due to persistent hypotension (MAP < 50mm Hg). These observations indicate that a bolus dose of Dex (1.0 µg/kg for 10 minutes) and high infusion rates may require fluid resuscitation or vasopressor support to maintain normotension in critically injured pediatric burn patients.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: Erik S
authors.initials: ES
authors.lastname: Shank
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sheridan
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Keaney
authors.forename: J A Jeevendra
authors.initials: JA
authors.lastname: Martyn
mesh_terms: D000293:Adolescent; D002056:Burns / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine