Dexmedetomidine: Applications in pediatric critical care and pediatric anesthesiology

Objective: To provide a general descriptive account of the end-organ effects of dexmedetomidine and to provide an evidence-based review of the literature regarding its use in infants and children. Data Source. A computerized bibliographic search of the literature regarding dexmedetomidine. Main Results. The end-organ effects of dexmedetomidine have been well studied in animal and adult human models. Adverse cardiovascular effects include occasional episodes of bradycardia with rare reports of sinus pause or cardiac arrest. Hypotension has also been reported as well as hypertension, the latter thought to be due to peripheral alpha(2B) agonism with peripheral vasoconstriction. Although dexmedetomidine has no direct effects on myocardial function, decreased cardiac output may result from changes in heart rate or increases in afterload. There are somewhat conflicting reports in the literature regarding its effects on ventilatory function, with some studies (both human and animal) suggesting a mild degree of respiratory depression, decreased minute ventilation, and decreased response to CO2 challenge whereas others demonstrate no effect. The central nervous system effects include sedation and analgesia with prevention of recall and memory at higher doses. Dexmedetomidine may also provide some neuroprotective activity during periods of ischemia. Applications in infants and children have included sedation during mechanical ventilation, prevention of emergence agitation following general anesthesia, provision of procedural sedation, and the prevention of withdrawal following the prolonged administration of opioids and benzodiazepines. Conclusions: The literature contains reports of the use of dexmedetomidine in approximately 800 pediatric patients. Given its favorable sedative and anxiolytic properties combined with its limited effects on hemodynamic and respiratory function, there is growing interest in and reports of its use in the pediatric population in various clinical scenarios.