Use of Continuous Dexmedetomidine at Home for Nearly Three Years in a Young Woman with End-Stage Cyanotic Congenital Heart Disease and Cyclic Vomiting

Thienprayoon, Rachel; Meyer, Mark J.; Flint, Hilary; Weidner, Norbert; Hirsch, Russel

doi:10.1089/jpm.2018.0516

Cited by 11 publications

(12 citation statements)

References 6 publications

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“…Please note, that 0.3 µg/kg/h is the initial dose chosen by Thomas et al (50) in their recent cohort study for palliative sedation. The 14 years old could be treated successfully at home for nearly 3 years until her death (66).…”

Section: Other Indications and Findings From Pediatric Palliative Carementioning

confidence: 99%

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Gaertner¹,

Fusi-Schmidhauser²

2022

Ann Palliat Med

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Background and Objective: Dexmedetomidine is a potent adrenergic alpha-2 receptor agonist. It was first approved for sedation for mechanically ventilated patients. Being a sedative medication that is not associated with respiratory depression and holding analgesic properties fosters the interest for this drug in the palliative care field. The primary objectives of this review were to identify the key indications for the real-world use of dexmedetomidine in palliative care and other disciplines.Methods: A narrative review after extensive PubMed search was performed from 1950 to present on October 21st 2021. The language of the publications was restricted to English, German, French and Italian.Key Content and Findings: (I) Current dexmedetomidine use. There is a growing body of evidence that dexmedetomidine may reduce the incidence and severity of delirium, reduce opioid-consumption and postoperative nausea in intensive care settings. It is also used to facilitate withdrawal from different substances (alcohol, opioids, heroin). Concerning safety aspects of the drug, some studies reported an increased rate of serious cardiovascular events in patients with pre-existing heart conditions due to bradycardia and arterial hypo-and hypertension. Since the drug has a main hepatic metabolism, dose reduction is mandatory in patients with hepatic impairment. (II) Dexmedetomidine and palliative care. There have been sporadic case reports about the successful use of dexmedetomidine in palliative care. Indications for symptom control included sedation for hyperactive delirium, cancer pain, opioid-induced-hyperalgesia, dystonia, cough, vomiting, shivering and dyspnea. It is mainly applied via the intravenous (i.v.), subcutaneous, but also nasal and, buccal routes. Admixture ("syringe-driver") studies showed that dexmedetomidine is compatible with morphine, hydromorphone, hyoscine and haloperidol. In 2021, a first prospective cohort study became available. Here, the authors reported promising result for dexmedetomidine use in hyperactive terminal delirium for reducing delirium intensity and agitation. Especially the unique "conscious sedation"or "awake sedation" that allows patients to arouse easily under sedation and report comfort or distress was discussed by the authors. Conclusions:In this review, we present the main findings for dexmedetomidine from palliative care settings and other disciplines. The potential benefits and criticalities of the drug are discussed and practical recommendations for its use are provided.

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Section: Other Indications and Findings From Pediatric Palliative Carementioning

confidence: 99%

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Gaertner¹,

Fusi-Schmidhauser²

2022

Ann Palliat Med

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“…One case report described continuous intravenous dexmedetomidine infusion for 76 days, and another intrathecal administration that was still ongoing when the report was written [29,39]. In pediatric palliative care, treatment lengths up to 111 days are described, and one adolescent palliative care patients used continuous dexmedetomidine in a home care setting for nearly 3 years [30,42]. One of our patients received dexmedetomidine for little less than 4 months, and we report almost 1 year of accumulated treatment experiences.…”

Section: Comparison With Previous Workmentioning

confidence: 78%

“…Several papers describe the prolonged use of dexmedetomidine in palliative care [29,30,39,42]. One case report described continuous intravenous dexmedetomidine infusion for 76 days, and another intrathecal administration that was still ongoing when the report was written [29,39].…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…However, the evidence base for its use in this group of patients is still limited [26]. For adults, case reports described symptom relief in patients with severe cancer pain and anxiety, and anecdotal papers reported positive effects on various symptoms like delirium, dyspnea, vomiting, and depression [8][9][10][27][28][29][30][31]. In terminally ill children, a recent systematic review, based on retrospective evidence, found dexmedetomidine for pain control to be significantly associated with improved quality of life [32].…”

Section: Introductionmentioning

confidence: 99%

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Emergency Palliative Cancer Care: Dexmedetomidine Treatment Experiences—A Retrospective Brief Report on Nine Consecutive Cases

et al. 2023

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Introduction: Dexmedetomidine, an alpha-2 adrenergic receptor agonist with potential opioid sparing properties, is utilized in palliative medicine, but the knowledge base for this practice is limited. We describe concomitant use of dexmedetomidine and opioids in an acute palliative care unit. Methods: We included all hospitalized palliative cancer care patients treated with dexmedetomidine from January 2019 to January 2021. Demographics, opioid doses, dexmedetomidine indications and dosing, reported effects and adverse responses, as well as treatment lengths were recorded. Results: Three women and six men aged 42--66 years with metastatic cancer and Eastern Cooperative Oncology Group (ECOG) performance status I-IV used dexmedetomidine and opioids concomitantly. Indications for dexmedetomidine were pain (n = 7) and anxiety (n = 2). Dexmedetomidine was administered intravenously in two patients and subcutaneously in seven. All administrations were continuous infusions; initial doses ranged from 240 to 1344 lg/24 h with later doses from 240 to 2440 lg/24 h. Physicians reported relief from pain and anxiety, but two patients required neuraxial pain management during admission. At day 2 of dexmedetomidine treatment, the opioid dose was reduced in six out of nine patients. For all patients with available data at day 7, mean opioid dose was reduced to 74% of the initial dose. When excluding the two patients requiring neuraxial pain management, the corresponding number was 80%. Two patients had transient hypotension, but dexmedetomidine was well tolerated and in no cases withdrawn due to adverse effects. Mean

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“…There is a single case report of the use of a continuous IV infusion of DEX for more than 2 years, without significant side effects (bradycardia, hypertension, or hypotension), in a 14-year-old with chronic heart failure and cyclic vomiting syndrome. 13 There is conflicting evidence about the potential for tolerance or withdrawal symptoms associated with DEX: Walker et al 14 reported on the use of IV DEX for an average of 11 days (range, 2-50 days) in pediatric burn patients in the intensive care unit. Their patients did not require any dose escalation, suggesting no development of tachyphylaxis to the drug.…”

Section: Discussionmentioning

confidence: 99%

Home Use of Intranasal Dexmedetomidine in a Child With An Intractable Sleep Disorder

Zen

Rizzo

Robazza³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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Sleep disturbance is a crucial issue in pediatric palliative care, with a dramatic impact on the quality of life of children and families. Dexmedetomidine (DEX) is a selective α-2 agonist, with anxiolytic, hypnotic, and analgesic properties, that could play a role in the management of refractory sleep disturbances. We describe the use of intranasal DEX as a sleep inductor in a 10-year-old female with dystrophic epidermolysis bullosa and a severe sleep disorder. After treatment with melatonin, benzodiazepines, and niaprazine had failed, she was admitted to the hospital where 3 mcg/kg/day of intranasal DEX was administered before bedtime. She received 0.7 mL of the IV formulation at a concentration of 100 mcg/mL with half the dose given in each nostril via a Mucosal Atomization Device. During this time, she was also monitored for potential side effects (e.g., bradycardia, blood pressure derangements). After 2 weeks of hospitalization, she was discharged with ready-to-use doses of DEX for home treatment. The child's heart rate and blood oxygen saturation were monitored at home. There was a definite improvement in sleep quality and duration, daytime alertness, pain control, and quality of life. No side effects were reported and the drug retained its effect over time (the patient is currently taking the drug). Intranasal DEX could be a safe and effective strategy to manage refractory sleep disturbances in children in pediatric palliative care.

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Use of Continuous Dexmedetomidine at Home for Nearly Three Years in a Young Woman with End-Stage Cyanotic Congenital Heart Disease and Cyclic Vomiting

Cited by 11 publications

References 6 publications

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Emergency Palliative Cancer Care: Dexmedetomidine Treatment Experiences—A Retrospective Brief Report on Nine Consecutive Cases

Home Use of Intranasal Dexmedetomidine in a Child With An Intractable Sleep Disorder

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