Incidence of bradycardia in pediatric patients receiving dexmedetomidine anesthesia: a meta-analysis

Abstract

Background Dexmedetomidine, an α2-receptor agonist, provides potent sedation, analgesia, and anxiolysis without respiratory depression and is used in a variety of surgical and procedural situations. Aim of the review The aim of this study was to estimate the incidence of bradycardia in pediatric patients who received dexmedetomidine as a sole agent for any procedural, intensive care or surgical sedation. Method Literature was searched in electronic databases and studies were selected by following pre-determined eligibility criteria. Meta-analyses were carried out by pooling the percent incidence of bradycardia to attain a weighted overall effect size. Age-wise subgroup analyses and meta-regression analyses for the identification of factors affecting the incidence were also performed. Results Data of 2835 patients from 21 studies were included. The mean age was 62.21 ± 35.68 months. Initial, maintenance and total doses of dexmedetomidine (mean ± standard deviation) were 1.63 ± 0.33 μg/kg body weight, 0.86 ± 0.68 μg/kg/h, and 26.7 ± 20.8 μg/kg. The overall incidence of bradycardia (95% confidence interval) was 3.067 (2.863, 3.270)%; P < 0.0001. However, range was wider (0-22%) with 9 studies observed 0% incidence. The mean change in the heart rate was -17.26 (-21.60, -12.92); P < 0.00001. In the meta-regression analyses, age, body weight and dexmedetomidine dose were not significantly associated with the incidence of bradycardia. The minimum heart rate observed during the dexmedetomidine treatment period was positively associated with baseline heart rate. Conclusion Incidence of bradycardia in dexmedetomidine treated pediatric patients is 3%.

Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Dental Patients under General Anesthesia: A Randomised Clinical Trial

“…Dexmedetomidine is increasingly used for premedication in children and is a novel α 2 agonist that exerts sedative, analgesic, and anxiolytic effects in a dose-dependent manner [10]. It is effective and safe for preoperative sedation in children, has some analgesic effects, and does not cause respiratory depression [11].…”

Dexmedetomidine as an Adjunct to Treat Anticholinergic Toxidrome in Children

“…Dexmedetomidine’s commonly reported side effects of hypotension and bradycardia offer a significant advantage in controlling peripheral manifestations of tachycardia and hypertension. 13 In contrast to physostigmine, dexmedetomidine may be used safely even in the presence of prolonged QTc. Dexmedetomidine may also diminish the associated fever and flushing by its effect on thermoregulation both centrally and peripherally.…”

Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

“…In a recently published meta-analysis, the pooled overall incidence of bradycardia in children who received dexmedetomidine sedation was 3.067%; mean reduction in heart rate from baseline was about 17 beats/minute. 11 Previous studies were based on small numbers of patients. Nevertheless, the risk factors for bradycardia associated with intranasal dexmedetomidine sedation are not well-characterized in a large-scale pediatric population.…”