Article Open Access http://dx.doi.org/10.26855/ijcemr.2020.01.001
Safety of Prolonged Dexmedetomidine Use in Pediatric Patients
Jennifer T. Wintergrass *, Anna Simmont, Catherine Chen, Kimberly Leuthner
Department of Pharmacy, University Medical Center of Southern Nevada.
*Corresponding author: Jennifer T. Wintergrass, PharmD, Department of Pharmacy, 1800W Charleston Blvd, Las Vegas, NV 89102.
Published: January 19,2020
Abstract
We evaluated the incidence of hemodynamic adverse events in children who received prolonged continuous dexmedetomidine for ≥ 192 hours. Prolonged infusions of dexmedetomidine may additionally contribute to hemodynamic adverse events at time of discontinuation. The current practices regarding use of dexmedetomidine at time of dexmedetomidine discontinuation were also evaluated. This was a retrospective, chart review of 14 children who had received prolonged continuous dexmedetomidine infusions. Demographics, dexmedetomidine infusion characteristics, systolic and diastolic blood pressure, heart rate, use of rescue medication, and clonidine use characteristics were evaluated during dexmedetomdine infusion through 24-hr after last dose of dexmedetomidine. Average age was 5 years (range 7 months – 17 years). Average length of continuous dexmedetomidine was 10 days (range 8 – 19 days). Average dose of dexmedetomidine during initiation and maintenance was 1.25 mcg/kg/hr. The maximum rate of dexmedetomidine was 1.6 mcg/kg/hr. Statistically significant higher adverse event incidence rate seen during dexmedetomidine wean compared to initiation and maintenance (36.2% and 0.04%, p<0.05). No differences were seen in rate of adverse events comparing patients who were weaned with and without clonidine (39.9% and 37.8%, p=0.52). Prolonged continuous infusions of dexmedetomidine were well-tolerated with doses up to 1.6 mcg/kg/hr. A higher incidence of adverse events were seen during the period of wean compared to period of initiation and maintenance. Clonidine use at wean was not found to have an effect on decreasing the amount of hemodynamic adverse events at discontinuation.
References
[1] Precedex® [package insert]. Lake Forest, IL: Hospira, Inc; 2016.
[2] Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992; 77:1125-33.
[3] Reiter PD, Pietras M, Dobyns EL. Prolonged dexmedetomidine infusions in critically ill infants and children. Indian Pediatr. 2009; 46: 767-73.
[4] Gupta P, Whiteside W, Sabati A et al. Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease. Pedriatr Crit Care Med. 2012; 150:660-6.
[5] Virtanen R, Savola JM, Saano V et al. Characterization of selectivity, specificity and potency of dexmedetomidine as alpha-2-adrenoreceptor agonist. Eur J Pharmacol. 1988; 150:9-14.
[6] Hammer GB, Phillip BM, Schroeder AR et al. Prolonged infusion of dexmedetomidine for sedation following tracheal resection. Paediatr Anaesth. 2005; 15:616-20.
[7] Bejian S, Valasek C, Nigro JJ et al. Prolonged use of dexmedetomidine in the paediatric cardiothoracic intensive care unit. Cardiol Young. 2009; 19: 98-104.
[8] Whalen LD, Di Gennaro JL, Irby GA et al. Long-term dexmedetomidine use and safety profile among critically ill children and neonates. Pediatr Crit Care Med. 2014; 15: 706-14.
[9] Lardieri AB, Fusco NM, Simone S et al. Effects of clonidine on withdrawal from long-term dexmedetomidine in the pediatric patient. J Pediatr Pharmacol Ther. 2015; 20:45-53.
How to cite this paper
Safety of Prolonged Dexmedetomidine Use in Pediatric Patients
How to cite this paper: Wintergrass, J. T., Simmont, A., Chen, C., Leuthner, K. (2020) Safety of Prolonged Dexmedetomidine Use in Pediatric Patients. International Journal of Clinical and Experimental Medicine Research, 4(1), 1-6.
DOI: http://dx.doi.org/10.26855/ijcemr.2020.01.001