Identifying a rapid bolus dose of dexmedetomidine (<scp>ED</scp>50) with acceptable hemodynamic outcomes in children

Dawes, Joy; Myers, Dorothy; Görges, Matthias; Zhou, Guohai; Ansermino, J. Mark; Montgomery, Carolyne J.

doi:10.1111/pan.12468

Cited by 47 publications

(31 citation statements)

References 28 publications

(37 reference statements)

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“…In this respect, the lack of adverse hemodynamic side effects reported by Kim et al are intriguing. They might be in line with recent reports on pediatric patients in whom a bolus injection was acceptable with hemodynamic responses [15]. …”

supporting

confidence: 90%

An introduction to the various role of dexmedetomidine

Kim

2016

Korean J Anesthesiol

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supporting

confidence: 90%

An introduction to the various role of dexmedetomidine

Kim

2016

Korean J Anesthesiol

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“…Conversely, hypertension and bradycardia have ensued after rapid intravenous boluses of dexmedetomidine, followed by vasodilation and moderate hypotension. [23][24][25] Dexmedetomidine is also known to inhibit sinoatrial and atrioventricular node function, which can lead to bradycardia, especially in children with rhythm disturbances. 26,27 While speculative, use of a drug that provides sedation by a distinctly different mechanism from that of traditional gamma-aminobutyric acid agonist or Nmethyl-D-aspartate antagonist sedatives and anesthetics could potentially avoid the neurocognitive abnormalities described following repeated exposures to these agents.…”

Section: Discussionmentioning

confidence: 99%

Dosing and efficacy of intranasal dexmedetomidine sedation for pediatric transthoracic echocardiography: a retrospective study

Miller

Divanović

Hossain

et al. 2016

Can J Anesth/J Can Anesth

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Purpose We designed this retrospective observational study on the use of a 2 -agonist dexmedetomidine to determine the optimum intranasal dose to achieve sedation for pediatric transthoracic echocardiography and to identify any dose-related adverse effects. Methods Outpatient children aged three months to three years with diverse diagnoses of congenital heart disease, including cyanotic cardiac defects, underwent transthoracic echocardiography under dexmedetomidine sedation. Aerosolized intranasal dexmedetomidine was administered with initial doses ranging from 1-3 lgÁkg -1 . A rescue dose of 1 lgÁkg -1 was administered if adequate sedation was not achieved within 45 min following the first dose. The primary study outcome was the achievement of adequate sedation to allow transthoracic echocardiography (TTE) scanning, including subxiphoid and suprasternal probe manipulation.Results Sedation with intranasal dexmedetomidine for transthoracic echocardiography was successful in 62 of the 63 (98%) patients studied, with an intranasal rescue dose required in 13 (21%) patients. Intranasal doses of dexmedetomidine 2.5-3.0 lgÁkg -1 were required for tolerating TTE probe placement, including subxiphoid and suprasternal manipulation, with minimal response and a 90% success rate. Excluding patients who required a second dose of dexmedetomidine, the mean (standard deviation) time from administration to achieving such sedation (onset time) was 26 (8) min for low-dose (1-2 lgÁkg -1 ) dexmedetomidine and 28 (8) min for moderate-dose (2.5-3.0 lgÁkg -1 ) dexmedetomidine (P = 0.33). Time from administration of low-dose dexmedetomidine to discharge, including TTE scan time, was 80 (14) min, and it increased with moderate-dose dexmedetomidine to 91 (22) min (P = 0.05). Mild to moderate bradycardia and hypotension were observed, but no interventions were required. Conclusion We found that aerosolized intranasal dexmedetomidine offers satisfactory conditions for TTE in children three months to three years of age with an optimal dose of 2.5-3.0 lgÁkg -1 administered under the supervision of a pediatric cardiac anesthesiologist. RésuméObjectif Nous avons conçu cette étude observationnelle rétrospective sur l'utilisation de la dexmédétomidine, un agoniste des récepteurs a 2 , afin de déterminer la dose intranasale optimale pour obtenir une sédation pour l'échocardiographie transthoracique chez l'enfant et d'identifier tout effet secondaire néfaste lié à la dose.Presentation: Children's Hospital of Philadelphia ''Cardiology 2015''; Scottsdale, AZ, USA.

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“…However, in a recent study,Dawes et al showed that 0.49 µg/kg can be used as a bolus over 5 seconds in children (age 5-9 years) without causing any significant hemodynamic compromise21 .The authors in this study used 0.5 µg/kg loading dose (in 2 divided doses) over 30 seconds, alternating with ketamine. In this way, both the groups received induction bolus over 30 seconds.In the present study, all of the cases were completed successfully, and there was no episode of hypoapnea or desaturation in the group DK.…”

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confidence: 86%

A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP

Goyal

Hasnain

Mittal

et al. 2016

Gastrointestinal Endoscopy

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Identifying a rapid bolus dose of dexmedetomidine (ED50) with acceptable hemodynamic outcomes in children

Abstract: The ED50 of dexmedetomidine administered over 5 s without significant hemodynamic compromise is 0.49 mcg·kg(-1). Further work is needed to determine the 'safe' (ED5 or less) and effective dose for desired perioperative clinical outcomes.

Cited by 47 publications

References 28 publications

An introduction to the various role of dexmedetomidine

An introduction to the various role of dexmedetomidine

Dosing and efficacy of intranasal dexmedetomidine sedation for pediatric transthoracic echocardiography: a retrospective study

A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP

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