Document Detail

Dexmedetomidine use in a pediatric cardiac intensive care unit: can we use it in infants after cardiac surgery?
MedLine Citation:
PMID:  19295456     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess clinical response of dexmedetomidine alone or in combination with conventional sedatives/analgesics after cardiac surgery.
DESIGN: Retrospective study.
SETTING: Pediatric cardiac intensive care unit.
PATIENTS: Infants and neonates after cardiac surgery.
MEASUREMENTS AND MAIN RESULTS: We identified 80 patients including 14 neonates, at mean age and weight of 4.1 +/- 3.1 months and 5.5 +/- 2 kg, respectively, who received dexmedetomidine for 25 +/- 13 hours at an average dose of 0.66 +/- 0.26 microgxkgxhr. Overall normal sleep to moderate sedation was documented 94% of the time and no pain to mild pain for 90%. Systolic blood pressure (SBP) decreased from 89 +/- 15 mm Hg to 85 +/- 11 mm Hg (p = .05), heart rate (HR) from 149 +/- 22 bpm to 129 +/- 16 bpm (p < .001), and respiratory rate (RR) remained unchanged. When baseline arterial blood gases were compared with the most abnormal values, pH decreased from 7.4 +/- 0.07 to 7.37 +/- 0.05 (p = .006), Po2 from 91 +/- 67 mm Hg to 66 +/- 29 mm Hg (p = .005), and CO2 increased from 45 +/- 8 mm Hg to 50 +/- 12 mm Hg (p = .001). At the beginning of the study, 37 patients (46%) were mechanically ventilated; and at 48 hours, 13 patients (16%) were still intubated and five patients failed extubation. Three groups of patients were identified: A, dexmedetomidine only (n = 20); B, dexmedetomidine with sedatives/analgesics (n = 38); and C, dexmedetomidine with both sedatives/analgesics and fentanyl infusion (n = 22). The doses of dexmedetomidine and rescue sedatives/analgesics were not significantly different among the three groups but duration of dexmedetomidine was longer in group C vs. A (p = .03) and C vs. B (p = .002). Pain, sedation, SBP, RR, and arterial blood gases were similar. HR was higher in group C vs. B (p = .01). Comparison between neonates and infants showed that infants required higher dexmedetomidine doses, 0.69 +/- 25 microgxkgxhr, and vs. 0.47 +/- 21 microgxkgxhr (p = .003) and had lower HR (p = .01), and RR (p = .009), and higher SBP (p < .001).
CONCLUSIONS: Dexmedetomidine use in infants and neonates after cardiac surgery was well tolerated in both intubated and nonintubated patients. It provides an adequate level of sedation/analgesia either alone or in combination with low-dose conventional agents.
Constantinos Chrysostomou; Joan Sanchez De Toledo; Tracy Avolio; Maria V Motoa; Donald Berry; Victor O Morell; Richard Orr; Ricardo Munoz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  10     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-09     Completed Date:  2010-01-26     Revised Date:  2012-06-18    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  654-60     Citation Subset:  IM    
Department of Pediatrics and Critical Care Medicine, Division of Cardiac Intensive Care, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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MeSH Terms
Age Factors
Analgesics, Non-Narcotic / administration & dosage,  adverse effects,  pharmacology,  therapeutic use*
Analgesics, Opioid / administration & dosage
Dexmedetomidine / administration & dosage,  adverse effects,  pharmacology,  therapeutic use*
Dose-Response Relationship, Drug
Drug Therapy, Combination
Drug Toxicity
Fentanyl / administration & dosage
Heart Defects, Congenital / surgery*
Hemodynamics / drug effects
Hypnotics and Sedatives / administration & dosage,  adverse effects,  pharmacology,  therapeutic use*
Infant, Newborn
Infusions, Intravenous
Intensive Care Units, Pediatric
Intubation, Intratracheal
Pain, Postoperative / prevention & control*
Respiration / drug effects
Retrospective Studies
Reg. No./Substance:
0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid; 0/Hypnotics and Sedatives; 113775-47-6/Dexmedetomidine; 437-38-7/Fentanyl
Comment In:
Pediatr Crit Care Med. 2010 Sep;11(5):645-6; author reply 646   [PMID:  20823746 ]
Erratum In:
Pediatr Crit Care Med. 2012 May;13(3):373

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