The use of dexmedetomidine to facilitate acute discontinuation of opioids after cardiac transplantation in children

Objective. To report the use of dexmedetomidine to facilitate rapid opioid and benzodiazepine withdrawal in children with transplanted hearts and to review the receptor physiology and pharmacodynamic impact of dexmedetomidine on the denervated heart. Design. Case series. Setting: Intensive care unit at a tertiary pediatric medical center. Patients. The series included a 6-month-old infant with pulmonary atresia who had a 3-month exposure to high-dose opioids and benzodiazepines and had undergone cardiac transplantation 4 wks before the use of dexmedetomidine and a 7-yr-old boy who had been sedated while undergoing extracorporeal membrane oxygenation for 3 wks before transplantation and started to receive dexmedetomidine 3 days after transplantation. Intervention: Administration of dexmedetomidine to facilitate the discontinuation of opioids and benzodiazepine. Main Result. Successful rapid withdrawal from opioids and benzodiazepines while maintaining hemodynamic stability. Conclusion. To our knowledge, this report describes the first use of dexmedetomidine to facilitate opioid withdrawal in children with a cardiac transplant. Dexmedetomidine allowed for the preservation of satisfactory hemodynamic parameters during acute withdrawal from opioids in children with denervated hearts.