Dexmedetomidine as a Rapid Bolus for Treatment and Prophylactic Prevention of Emergence Agitation in Anesthetized Children

Hauber, John A.; Davis, Peter J.; Bendel, Laima P.; Martyn, Slava V.; McCarthy, Denise L.; Evans, Minh-Chau; Cladis, Franklyn P.; Cunningham, Sarah; Lang, Robert Scott; Campbell, Neal F.; Tuchman, Jay B.; Young, Michael C.

doi:10.1213/ane.0000000000000931

Cited by 80 publications

(62 citation statements)

References 32 publications

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“…This paradoxical response to dexmedetomidine has been previously described [4] after a high-dose dexmedetomidine intravenous bolus, and it is believed to be due to activation of α 2B peripheral adrenergic receptors leading to vasoconstriction and increased systemic vascular resistance [11, 17]. Interestingly, this patient had received dexmedetomidine in a previous admission and experienced the expected decrease in BP and HR.…”

Section: Discussionsupporting

confidence: 53%

Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia

et al. 2016

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Objective Adrenergic crises are a cardinal feature of familial dysautonomia (FD). Traditionally, adrenergic crisis have been treated with the sympatholytic agent clonidine or with benzodiazepines, which can cause excessive sedation and respiratory depression. Dexmedetomidine is an α2A-adrenergic agonist with greater selectivity and shorter half-life than clonidine. We aimed to evaluate the preliminary effectiveness and safety of intravenous dexmedetomidine in the treatment of refractory adrenergic crisis in patients with FD. Methods Retrospective chart review of patients with genetically confirmed FD who received intravenous dexmedetomidine for refractory adrenergic crises. The primary outcome was preliminary effectiveness of dexmedetomidine defined as change in blood pressure (BP) and heart rate (HR) 1-hour after the initiation of dexmedetomidine. Secondary outcomes included incidence of adverse events related to dexmedetomidine, hospital and intensive care unit (ICU) length of stay, and hemodynamic parameters 12-hours after dexmedetomidine cessation. Results Nine patients over 14 admissions were included in the final analysis. At 1-hour after the initiation of dexmedetomidine, systolic BP decreased from 160±7 to 122±7 mmHg (p=0.0005), diastolic BP decreased from 103±6 to 65±8 (p=0.0003), and HR decreased from 112±4 to 100±5 bpm (p=0.0047). The median total adverse events during dexmedetomidine infusion was 1 per admission. Median hospital length of stay was 9 days (IQR, 3 – 11 days) and median ICU length of stay was 7 days (IQR, 3 – 11 days). Conclusions Intravenous dexmedetomidine is safe in patients with FD and appears to be effective to treat refractory adrenergic crisis. Dexmedetomidine may be considered in FD patients who do not respond to conventional clonidine and benzodiazepine pharmacotherapy.

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Section: Discussionsupporting

confidence: 53%

Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia

et al. 2016

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“…Dexmedetomidine is a highly selective α2‐adrenoceptor agonist with sedative, analgesic, and anxiolytic actions without respiratory depression, and it has been widely used in various clinical situations . Dexmedetomidine appears to be effective in a wide range of doses and is reported to have a short half‐life, about 1.8 hours .…”

Section: Discussionmentioning

confidence: 99%

“…Having an objective and validated scoring system to define EA is critical. Several scales have been used to assess EA; among them, the PAED scale by Sikich and Lerman and five scales by Cole et al have been validated and are used widely . In several studies, the two scoring systems showed similar results and were complementary in some parts .…”

Section: Discussionmentioning

confidence: 99%

“…Fifteen studies with 1,552 participants were included for the meta‐analysis, and the results of the study characteristics were described in Table . Outcomes for analysis were postoperative pain (pain scores) in the postanesthesia care unit (PACU), postoperative analgesic requirements (doses of postoperative opioids or nonopioid analgesics), postoperative agitation (agitation scores and incidence during recovery), desaturation, and residual sedation (time to discharge from PACU) . These outcomes were compared between perioperative dexmedetomidine groups and control groups (patients receiving conventional pain control agents or patients who received sham treatments) during a postoperative period (0–24 hours after leaving the operating room).…”

Section: Methodsmentioning

confidence: 99%

“…Dexmedetomidine, an alpha‐2 adrenoceptor agonist, has sympatholytic, sedative, anesthetic, and algesic effects—as well as vasoconstrictive effects . During the past few years, dexmedetomidine has reportedly been used in pediatrics as a premedication, a sedation agent used in pediatric intensive care units, an adjunct to inhaled anesthetic agents, and a drug for both prophylaxis and treatment of EA after general anesthesia . The results of several recent studies on the use of perioperative adjuvant dexmedetomidine are encouraging, showing beneficial effects on postoperative morbidities such as pain and agitation in pediatric patients .…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis

Cho¹,

Yoon

Jin

et al. 2017

The Laryngoscope

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Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

et al. 2022

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Background and Aim Radiofrequency ablation (RFA) therapy is frequently used as first‐line treatment for small hepatocellular carcinoma (HCC). RFA is often associated with pain; however, no definitive solution has been established for its relief. We retrospectively analyzed the safety and efficacy of the combination of pentazocine and midazolam to relieve pain experienced by HCC patients undergoing RFA. Methods We studied 77 patients with 98 HCCs treated with RFA between January 2015 and August 2019. Patients were divided into two groups: the sedative‐free group, which included those who received pentazocine alone, and the pentazocine–midazolam group, which included those who received a combination of pentazocine and midazolam. The degrees of analgesia and sedation were evaluated using the numerical rating scale (NRS) and the Richmond Agitation‐Sedation Scale (RASS), respectively. Other parameters such as treatment time, awakening time, midazolam dosage, vital signs, local recurrence rate, and time to recurrence were also examined. Results The median NRS score and RASS score were significantly lower in the pentazocine–midazolam group. Ninety‐five percent of patients in the pentazocine–midazolam group had no memory of the RFA session. The treatment time and awakening time were prolonged for the pentazocine–midazolam group. No significant differences in oxygen saturation, recurrence rates, and time to local recurrence were observed between groups. Conclusion A combination of pentazocine and midazolam is safe and effective for pain and anxiety relief experienced by patients undergoing RFA for local treatment of HCC.

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Dexmedetomidine as a Rapid Bolus for Treatment and Prophylactic Prevention of Emergence Agitation in Anesthetized Children

Cited by 80 publications

References 32 publications

Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia

Dexmedetomidine for refractory adrenergic crisis in familial dysautonomia

Efficacy of dexmedetomidine for perioperative morbidities in pediatric tonsillectomy: A metaanalysis

Safety and efficacy of pentazocine–midazolam combination for pain and anxiety relief in radiofrequency ablation therapy for hepatocellular carcinoma

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