Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients

Oschman, Alexandra; McCabe, Tara; Kuhn, Robert J.

doi:10.2146/ajhp100257

Cited by 48 publications

(41 citation statements)

References 28 publications

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“…[31] It counters the physiologic effects of withdrawal secondary to decrease in sympathetic outflow and noradrenergic activity, mediated mainly through postsynaptic α2-AR subtype in the locus ceruleus. [3233] It has potential for treatment of agitation and alcohol withdrawal in alcoholic patients after brain trauma, who require reliable, serial neurological testing to monitor the course of their traumatic brain injury. [34] This neuroprotective property is attributed to its preservation of sleep architecture and ventilatory drive with decreased sympathetic tone and inflammatory responses.…”

Section: Sole Agent For Procedural Sedationmentioning

confidence: 99%

Dexmedetomidine: New avenues

Grewal

2011

J Anaesthesiol Clin Pharmacol

192

161

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Section: Sole Agent For Procedural Sedationmentioning

confidence: 99%

Dexmedetomidine: New avenues

Grewal

2011

J Anaesthesiol Clin Pharmacol

192

161

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“…55,57 Oschman et al show that the use of other drugs is possible in the treatment of abstinence, such as dexmedetomidine and clonidine. 67 Delirium Delirium represents an acute cerebral dysfunction, characterized by an altered mental state and behavior. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) definition, diagnostic criteria for delirium include: disruption of attention and consciousness, accompanied by cognitive impairment (memory, orientation, language, and perception) that cannot be explained by other previous neurocognitive disturbances; this develops in hours or days, frequently with fluctuations throughout the day and worsening during nighttime, and there is evidence that these effects result from clinical conditions or treatment (infection, cancer, metabolic or endocrine alterations, use of sedatives).…”

Section: Resultsmentioning

confidence: 99%

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Motta

Luglio²,

Delgado

et al. 2016

Rev. Assoc. Med. Bras.

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Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

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“…This is mainly attributed to their blocking of α −2 A receptors situated in the locus ceruleus. [8182] It has been found to be helpful controlling the agitation in alcoholics after traumatic brain injury and thus helps in monitoring and allows serial neurotesting in these patients. [83]…”

Section: Therapeutic Role In Opioid and Alcohol Withdrawalmentioning

confidence: 99%

Dexmedetomidine: An adjuvant making large inroads into clinical practice

Bajwa

Kulshrestha

2013

Ann Med Health Sci Res

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The introduction of newer more selective α−2 adrenergic agonist, dexmedetomidine has made a revolution in the field of anesthesia owing to its varied application. The aim of the current review is to highlight the various clinical and pharmacological aspects of dexmedetomidine in daily routine practice of anesthesiology and intensive care besides its potential role in other clinical specialties. This review of dexmedetomidine was carried out after searching the medical literature in Pubmed, Science direct, Scopus, Google scholar and various text books and journal articles using keywords anesthesia, dexmedetomidine, neurosurgery, pediatric surgery, regional dexmedetomidine, anesthesia, regional, neurosurgery, and pediatric surgery. Dexmedetomidine has made its application from a novel sedating agent in the intensive care unit to its use as an adjuvant in various regional anesthetic techniques because of its “cooperative sedation” without any respiratory depression. It has a favorable pharmacokinetic profile suitable to be used in the perioperative period to reduce the requirements of opioids and anesthetic drugs. There are few side-effects of dexmedetomidine, which should always be kept in mind before choosing the patients for its use. The various side-effects associated with dexmedetomidine include, but are not limited to hypotension, bradycardia, worsening of heart block, dry mouth, and nausea. However, large scale randomized controlled trials are still needed to establish various effects of dexmedetomidine and to clearly define its safety profile.

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Dexmedetomidine for opioid and benzodiazepine withdrawal in pediatric patients

Abstract: A limited body of published evidence from retrospective studies and case reports suggests a potential role for dexmedetomidine as an adjunct therapy to provide sedation and analgesia to reduce narcotic withdrawal symptoms in pediatric patients.

Cited by 48 publications

References 28 publications

Dexmedetomidine: New avenues

Dexmedetomidine: New avenues

Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

Dexmedetomidine: An adjuvant making large inroads into clinical practice

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