Safety and Efficacy of Dexmedetomidine in Children With Heart Failure

Abstract

This retrospective observational study aimed to evaluate the safety and efficacy of dexmedetomidine (DEX) for children with heart failure. The study was conducted in the cardiovascular intensive care unit (CVICU) of a single, tertiary care, academic children's hospital. A retrospective review of the charts for all children (up to 18 years of age) with signs and symptoms consistent with congestive heart failure who received DEX in our CVICU between April 2006 and April 2011 was performed. The patients were divided into two groups for study purposes: the DEX group of 21 patients, who received a DEX infusion together with other conventional sedation agents, and the control group of 23 patients, who received conventional sedation agents without the use of DEX. To evaluate the safety of DEX, physiologic data were collected including heart rate, mean arterial pressure (MAP), and inotrope score. To assess the efficacy of DEX, the amount and duration of concomitant sedation and analgesic infusions in both the DEX and control groups were examined. The numbers of rescue boluses for each category before the initiation of sedative infusion and during the sedative infusion also were examined. The baseline characteristics of the patients in the two groups were similar. There was no effect of DEX infusion on heart rate, MAP, or inotrope score at the termination of infusion. The daily amount of midazolam administered was significantly less during the last 24 h of DEX infusion in the DEX group than in the control group (p = 0.04). The daily amount of morphine infusion did not differ between the DEX and control groups during any period. The numbers of sedation and analgesic rescue boluses were lower in DEX group throughout the infusion. No other significant side effects were noted. Two patients in the DEX group had a 50 % or greater drop in MAP compared with baseline in the first 3 h after initiation of DEX infusion, whereas one patient had a 50 % or greater drop in heart rate compared with baseline in the first 3 h after initiation of DEX infusion. Administration of DEX for children with heart failure appears to be safe but should be used cautiously. Furthermore, DEX use is associated with a decreased opiate and benzodiazepine requirement for children with heart failure.

Comparing the Effects of Dexmedetomidine and Midazolam on Sedation in Children with Head Trauma to Perform CT in Emergency Department / Upoređivanje efekata deksmedetomidina i midazolama na sedaciju dece sa povredom glave radi snimanja CT-om na Odeljenju urgentne medicine

“…No study has compared Dexmedetomidine and Midazolam to provide sedition in children for performing CT. No significant difference was observed between the effects of these drugs in providing sedition for patients referring to the ICU which is compatible with the findings of the current study. In the study which has compared the effect of Dexmedetomidine and Midazolam on patients undergoing cataract surgery, Dexmedetomidine showed no preferences over Midazolam and has the same performance which is compatible with the results of the present study (7,8,9).…”

“…Drugs used so far to provide sedation in children are Cholorohydrates and Pentobarbitals. These drugs have long-term effect which causes increase of the recovery time and level of side effects (7,8).…”

Drugs That May Cause or Exacerbate Heart Failure

“…In a small, retrospective, observation study of children with HF, dexmedetomidine did not affect heart rate, mean arterial pressure, or inotrope score at the termination of infusion; however, 2 patients had a 50% decrease in mean arterial pressure and 1 patient had a 50% decrease in heart rate compared with baseline in the first 3 hours of infusion. 30 In neurocritical care patients, dexmedetomidine exhibited similar incidences of severe hypotension (mean arterial pressure <60 mm Hg) and bradycardia (heart rate <50 bpm) compared with propofol. 31 …”

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

“…48 Other studies showed that the use of dexmedetomidine is safe in patients with congenital heart diseases and in the post-operatory of cardiac surgery without hypotension and bradycardia harmful to the patient. [49][50][51][52][53] Management of abstinence syndrome Prolonged administration of opioids and/or benzodiazepines leads to tolerance. Rapid suspension of these medications implicates a myriad of signs and symptoms, called abstinence syndrome.…”