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Prolonged use of dexmedetomidine in the paediatric cardiothoracic intensive care unit

Published online by Cambridge University Press:  20 January 2009

Sharon Bejian ,
Cassie Valasek ,
John J. Nigro ,
David C. Cleveland  and
Brigham C. Willis
Sharon Bejian
Affiliation:
Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
Cassie Valasek
Affiliation:
Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
John J. Nigro
Affiliation:
Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
David C. Cleveland
Affiliation:
Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona
Brigham C. Willis*
Affiliation:
Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona Department of Pediatrics, University of Arizona, Tucson, Arizona, United States of America
*
Correspondence to: Brigham C. Willis, M.D. Clinical Associate Professor of Pediatrics, University of Arizona, Eller Congenital Heart Center, St. Joseph’s Hospital and Medical Center, 500 W. Thomas Rd., Suite 500, Phoenix, AZ 85013, United States of America. Tel: (602) 406-2670; Fax: (602) 294-5273; E-mail: brigham.willis@chw.edu
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Abstract

Background

Dexmedetomidine is an α2-adrenergic agonist that causes sleep-like sedation and mild analgesia without narcosis or respiratory depression, and has relative cardiovascular stability. Due to these properties, it may be an effective agent for prolonged use in the sedation of patients in the paediatric cardiothoracic intensive care unit. We reviewed our experience with the drug to detail its safety and efficacy.

Methods

We conducted a retrospective chart review of all patients who received dexmedetomidine over a six month period in a dedicated paediatric cardiothoracic intensive care unit. Patients were identified from pharmacy records showing administration of drugs. We collected demographic data, information relating to doses of dexmedetomidine, physiologic parameters, and clinical outcomes.

Results

We identified 54 patients who received the drug. The median age of recipients was 6 months, with a range from 1 day to 16 years. The mean duration of administration was 37.3 hours, with a range from 2 to 177 hours. The mean duration of continuation of administration after extubation was 16.7 hours, with a range from zero to 112.5 hours. Physiologically, there were no clinically significant changes in mean arterial pressure, heart rate, respiratory rate, or saturations of oxygen before, during, or after utilization of the drug. Use of dexmedetomidine significantly reduced the need to administrate narcotics, and scores using the COMFORT system were not different between patients who received dexmedetomidine and those who did not.

Conclusions

In this limited and retrospective review, dexmedetomidine was found to be safe and efficacious. Its use as a sedative agent for extended periods of time in critically-ill children deserves investigation in a prospective and controlled manner.

Keywords

Sedationcardiac surgerycritical care
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 1 , February 2009 , pp. 98 - 104
Copyright
Copyright © Cambridge University Press 2009

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