Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease

• Published in: Intensive care medicine 2012-02, Vol.38 (2), p.300-307
• Main Authors: Burbano, Nelson H., Otero, Andrea V., Berry, Donald E., Orr, Richard A., Munoz, Ricardo A.
• Format: Article
• Language: English
• Subjects: Adolescent; Age; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Cardiac arrhythmia; Cardiac patients; Cardiovascular disease; Child; Child, Preschool; Children; Critical care; Critical Care Medicine; Critical Illness; Dexmedetomidine; Dexmedetomidine - administration & dosage; Drug dosages; Drug withdrawal; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Emergency Medicine; FDA approval; Female; Health aspects; Heart Diseases - therapy; Heart rate; Hemodynamics; Hospitals; Humans; Hypertension; Hypnotics and Sedatives - administration & dosage; Infant; Intensive; Intensive care; Intensive care medicine; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Pain; Pain Medicine; Patients; Pediatric cardiology; Pediatric intensive care; Pediatric Original; Pediatrics; Pneumology/Respiratory System; Retrospective Studies; Tachycardia; Time Factors; Vital signs; Weaning; Withholding Treatment
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-011-2441-8

Purpose To describe changes in hemodynamic variables, sedation, and pain score after discontinuation of prolonged infusions of dexmedetomidine in a pediatric population of critically ill cardiac patients. Methods Retrospective case series of patients who received continuous infusions of dexmedetomidine for longer than 3 days in a pediatric cardiac intensive care unit from 2008 to 2010. Results Sixty-two patients, age 5.2 months (range 0.3 months–17 years) and weight 5.1 kg (range 2.2–84 kg), were included. Thirty-nine patients (63%) were younger than 1 year of age. Median duration of dexmedetomidine infusion was 5.8 days (range 4–26 days) and median infusion dose was 0.71 μg/kg/h (range 0.2–2.1 μg/kg/h). Median weaning time and dose at discontinuation were 43 h (range 0–189 h) and 0.2 μg/kg/h (range 0.1–1.3 μg/kg/h). Tachycardia, transient hypertension and agitation were observed in 27, 35 and 27% of patients. Episodes of tachycardia were more frequent in children older than 1 year of age (61 vs. 8%, p