Off-label use of dexmedetomidine in paediatric anaesthesiology: an international survey of 791 (paediatric) anaesthesiologists

Abstract

Purpose The purpose of this international study was to investigate prescribing practices of dexmedetomidine by paediatric anaesthesiologists. Methods We performed an online survey on the prescription rate of dexmedetomidine, route of administration and dosage, adverse drug reactions, education on the drug and overall experience. Members of specialist paediatric anaesthesia societies of Europe (ESPA), New Zealand and Australia (SPANZA), Great Britain and Ireland (APAGBI) and the USA (SPA) were consulted. Responses were collected in July and August 2019. Results Data from 791 responders (17% of 5171 invitees) were included in the analyses. Dexmedetomidine was prescribed by 70% of the respondents (ESPA 53%; SPANZA 69%; APAGBI 34% and SPA 96%), mostly for procedural sedation (68%), premedication (46%) and/or ICU sedation (46%). Seventy-three percent had access to local or national protocols, although lack of education was the main reason cited by 26% of the respondents not to prescribe dexmedetomidine. The main difference in dexmedetomidine use concerned the age of patients (SPA primarily < 1 year, others primarily > 1 year). The dosage varied widely ranging from 0.2–5 μg kg−1 for nasal premedication, 0.2–8 μg kg−1 for nasal procedural sedation and 0–4 μg kg−1 intravenously as adjuvant for anaesthesia. Only ESPA members (61%) had noted an adverse drug reaction, namely bradycardia. Conclusion The majority of anaesthesiologists use dexmedetomidine in paediatrics for premedication, procedural sedation, ICU sedation and anaesthesia, despite the off-label use and sparse evidence. The large intercontinental differences in prescribing dexmedetomidine call for consensus and worldwide education on the optimal use in paediatric practice.

Efficacy and Safety of Intranasal Dexmedetomidine vs. Oral Chloral Hydrate for Sedation in Children Undergoing Computed Tomography/Magnetic Resonance Imaging: A Meta-Analysis

“…In the case of sedation failure, it can also be re-administered (dose range of 1–4 μg/kg, usually 1 μg/kg). Intranasal administration of DEX has an average onset time of 30–40 min and an average time to awakening of about 90 min, and its main adverse reactions are hypotension and bradycardia, but the symptoms are mild and do not require therapeutic support ( 31 ).…”

Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial

“…To overcome this difficulty, it is often necessary to perform clinical sedation or general anesthesia to ensure a successful examination of MRI. Due to the cost of general anesthesia, MRI examination assisted by sedation is a simple and effective method and has become a new direction of research in this field [ 1 , 2 ].…”

Improved postoperative recovery profile in pediatric oral rehabilitation with low-dose dexmedetomidine as an opioid substitute for general anesthesia: a randomized double-blind clinical trial

“…Anesthesiologists generally use dexmedetomidine in the pediatric population for premedication and procedural sedation as an opioid-sparing agent [ 27 ], and to avert and treat postoperative emergence agitation [ 14 ]. Although there is a substantial body of evidence on dexmedetomidine use in pediatric patients, studies on its opioid-equivalent efficacy and recovery characteristics are scarce.…”