Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations

Abstract

Despite lack of paediatric labelling, contributions to the literature on paediatric applications of dexmedetomidine have increased over recent years. Dexmedetomidine possesses many properties that are advantageous for a sedative and anaesthetic; it has been reported to provide sedation that parallels natural sleep, anxiolysis, analgesia, sympatholysis, and an anaesthetic-sparing effect with minimal respiratory depression. In addition, there is increasing evidence supporting its organ-protective effects against ischaemic and hypoxic injury. These favourable physiological effects combined with a limited adverse effect profile make dexmedetomidine an attractive adjunct to anaesthesia (general and regional) for a variety of procedures in paediatric operating rooms. A comprehensive understanding of the pharmacological, pharmacokinetic, and pharmacodynamic effects of dexmedetomidine is critical to maximize its safe, efficacious, and efficient paediatric perioperative applications. This review focuses on the current paediatric perioperative and periprocedural applications of dexmedetomidine and its limitations, with a consideration for the future.

Effect of Anesthesia on the Developing Brain: Infant and Fetus

“…Dexmedetomidine is not US FDA labeled for use in patients under 18 years of age; however, it has attained widespread use in pediatric anesthesiology and critical care. It is utilized for postoperative sedation, as a component of total intravenous anesthesia regimens, for opioid-sparing in tonsillectomy, and also for premedication, procedural sedation, prevention of postoperative emergence agitation, and as a component of a balanced general anesthetic technique [33] . Among dexmedetomidine's desirable properties are its ability to maintain normal respiratory patterns, reduce the incidence of postcardiac surgical tachydysrhythmias [34] , and reduce doses of volatile anesthetic agents and opioids when utilized as a component of a balanced anesthetic technique [33] .…”

“…It is utilized for postoperative sedation, as a component of total intravenous anesthesia regimens, for opioid-sparing in tonsillectomy, and also for premedication, procedural sedation, prevention of postoperative emergence agitation, and as a component of a balanced general anesthetic technique [33] . Among dexmedetomidine's desirable properties are its ability to maintain normal respiratory patterns, reduce the incidence of postcardiac surgical tachydysrhythmias [34] , and reduce doses of volatile anesthetic agents and opioids when utilized as a component of a balanced anesthetic technique [33] . Dexmedetomidine has a significant body of research and clinical publication in children; a recent PubMed search revealed over 500 publications in children 0-18 years, and 200 in children birth to 2 years of age.…”

Spots on Prevention of Emergence Delirium and Agitation in Children Using Dexmedetomidine

“…Extreme bradycardia can occur if dexmedetomidine is administered to a patient receiving digoxin, β-adrenergic blockers, calcium channel blockers, and others. Although decreases in HR and a biphasic effect on BP are observed with increasing doses of dexmedetomidine [13].…”

Upper Airway Reflexes are Preserved During Dexmedetomidine Sedation in Children With Down Syndrome and Obstructive Sleep Apnea

“…9 Sleep architecture during DEX infusion is exclusively non-rapid eye movement (NREM) and is limited to stage 1 and stage 2 sleep. Neither slow wave nor rapid eye movement sleep are observed during DEX infusion.…”