Pediatric Anesthesia

Dexmedetomidine in Children: Current Knowledge and Future Applications

Mason KP, Lerman J (Children’s Hosp Boston, MA; Univ of Rochester, NY) Anesth Analg 113:1129-1142, 2011^§

Abstract

More than 200 studies and reports have been published regarding the use of dexmedetomidine in infants and children. We reviewed the English literature to summarize the current state of knowledge of this drug in children for the practicing anesthesiologist. Dexmedetomidine is an effective sedative for infants and children that only minimally depresses the respiratory system while maintaining a patent airway. However, dexmedetomidine does depress the cardiovascular system. Specifically, bradycardia, hypotension, and hypertension occur to varying degrees depending on the age of the child. Hypertension is more prevalent when larger doses of dexmedetomidine are given to infants. Consistent with its 2-hour elimination half-life, recovery after dexmedetomidine may be protracted in comparison with other sedatives. Dexmedetomidine provides and augments analgesia and diminishes shivering as well as agitation postoperatively. The safety record of dexmedetomidine suggests that it can be used effectively and safely in children, with appropriate monitoring and interventions to manage cardiovascular sequelae (Fig 4).

Figure 4 Three-thousand five-hundred twenty-two children received dexmedetomidine per protocol: initial bolus of 3 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 2 μg/kg/h to maintain a Ramsay Sedation Score (RSS) of 4. If at any point during the sedation, the child failed to achieve or maintain RSS 4, this bolus could be repeated up to 2 more times. The most frequent incidence of hypertension occurred in children <1 year of age who received more than 1 bolus (P < 0.001). From Mason,⁵³ publisher permission obtained. Editor’s Note: Please refer to original journal article for full references. (Reprinted from Mason KP, Lerman J. Dexmedetomidine in children: current knowledge and future applications. Anesth Analg. 2011;113:1129-1142, with permission from International Anesthesia Research Society.)

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