title: The Use of Dexmedetomidine in Pediatric Palliative Care: A Preliminary Study.
abstract: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies.
  
  
  
  Pediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores. While opioids are the mainstay of analgesic therapy, in some patients, increasing opioid use can be ineffective and can be associated with increasing pain during end of life. Dexmedetomidine, a α2-adrenoreceptor agonist with sedative and analgesic properties but without respiratory depressant effects, has been shown to reduce opioid requirement and to facilitate opioid weaning.
  
  
  
  Observational cohort study of consecutive patients treated with dexmedetomidine during end of life in a pediatric hospital. Primary outcomes included pain scores and morphine-equivalent intake.
  
  
  
  We identified nine patients [median age 8 (interquartile range; IQR 0.55-17 years)] who during end of life had received dexmedetomidine infusions. In these patients, dexmedetomidine infusions had a median duration of two days (IQR 1.5-12 days) and were associated with significant (p < 0.001) reductions in pain scores and a trend toward decreasing morphine-equivalent intake. There were no hemodynamic changes requiring vasoactive or anticholinergic agents.
  
  
  
  These preliminary findings of beneficial effects of dexmedetomidine support the hypothesis that dexmedetomidine has a role in palliative care of children and adolescents during end of life.
authors.affiliation: 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC.
authors.forename: Jamie
authors.initials: J
authors.lastname: Burns
authors.affiliation: 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC.
authors.forename: Kevin
authors.initials: K
authors.lastname: Jackson
authors.affiliation: 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC.
authors.forename: Kathy A
authors.initials: KA
authors.lastname: Sheehy
authors.affiliation: 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC.|2 George Washington University School of Medicine and Health Sciences , Washington, DC.
authors.forename: Julia C
authors.initials: JC
authors.lastname: Finkel
authors.affiliation: 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC.|2 George Washington University School of Medicine and Health Sciences , Washington, DC.|3 Center for Neuroscience Research, Children's National Health System, Children's Research Institute , Washington, DC.
authors.forename: Zenaide M
authors.initials: ZM
authors.lastname: Quezado
mesh_terms: D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D010166:Palliative Care / Q000379:methods
chemical_list: D018712:Analgesics, Non-Narcotic; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
keywords: agitation; pain control; pediatric pain control; pediatric palliative care; symptom control