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Pediatr Crit Care Med. 2005 Jul;6(4):435-9; quiz 440.

Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children.

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1
AssPediatrics/Pediatric Critical Care, University of Louisville, Kosair Children's Hospital, Louisville, KY, USA.

Abstract

OBJECTIVE:

Children often require sedation for lengthy noninvasive procedures. Conventional agents such as chloral hydrate, benzodiazepines, or barbiturates have been associated with sedation failure, respiratory depression, and paradoxic agitation. Dexmedetomidine is a newer alpha(2)-adrenergic receptor agonist with sedative properties and minimal respiratory depression. We hypothesized that it would be an effective agent for these procedures.

DESIGN:

Prospective case series.

SETTING:

Tertiary care children's hospital.

PATIENTS:

Children undergoing noninvasive procedures.

INTERVENTIONS:

Children were sedated with dexmedetomidine given as a bolus of 0.5-1.0 microg/kg over 5-10 mins followed by an infusion of 0.5-1.0 microg/kg/hr. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded.

MEASUREMENTS AND MAIN RESULTS:

Forty-eight patients, aged 6.9 +/- 3.7 yrs, were sedated. Fifteen received dexmedetomidine after failing sedation with chloral hydrate and/or midazolam. Sedation was induced with 0.92 +/- 0.36 microg/kg over 10.3 +/- 4.7 mins and maintained with an infusion of 0.69 +/- 0.32 microg/kg/hr. All procedures were completed. Heart rate, blood pressure, and respiratory rate decreased (p < .0001) but remained within normal limits for age. End-tidal CO(2) exceeded 50 mm Hg in seven of 404 measurements (1.7%). Mean recovery time was 84 +/- 42 mins and was significantly longer in the rescue (117 +/- 41 mins) vs. primary (69 +/- 34 mins) group (p < .0001). No patient developed agitation during recovery.

CONCLUSIONS:

Dexmedetomidine provided effective sedation in children undergoing noninvasive procedures and represents an alternative sedative choice for this population.

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[Indexed for MEDLINE]

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