title: A cannabinoid-intoxicated child treated with dexmedetomidine: a case report.
abstract: BACKGROUND
  In the last 20 years, the rate of exposure to marijuana has increased dramatically, even in the pediatric population. Effects of intoxication are variable, more severe neurological symptoms can be observed following ingestion, thus hospital or intensive care unit admission is often required. Usually cannabinoids intoxicated patients are treated with administration of benzodiazepines or opioids, accepting the related risk of intubation and mechanical ventilation. Dexmedetomidine is a highly selective α2-adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives. To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient.
  
  
  METHODS
  A 19-month-old Caucasian boy was presented to our emergency department. At the time of his arrival, he was somnolent with paroxysms of agitation, breathing spontaneously and hemodynamically stable. The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ(9)-tetrahydrocannabinol. The patient was admitted to the pediatric intensive care unit and treated with a continuous infusion of dexmedetomidine.
  
  
  CONCLUSIONS
  Dexmedetomidine is a fairly safe and effective antidote for pediatric marijuana or natural cannabinoid exposures. Its properties and potential to allow for "cooperative" sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.
authors.affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. flora.cipriani@yahoo.com.
authors.forename: Flora
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. aldomancino@gmail.com.
authors.forename: Aldo
authors.initials: A
authors.lastname: Mancino
authors.affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. smaria.pulitano@rm.unicatt.it.
authors.forename: Silvia Maria
authors.initials: SM
authors.lastname: Pulitanò
authors.affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. marco_piastra@yahoo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. g.conti@rm.unicatt.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
mesh_terms: D000931:Antidotes / Q000627:therapeutic use; D002186:Cannabinoids / Q000506:poisoning*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D008297:Male
chemical_list: D000931:Antidotes; D002186:Cannabinoids; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine