Initial Experience With Single Dose Dexmedetomidine For Procedural Sedation In Pediatric Patients: Case Reports

摘要

Objective: Several studies have evaluated the efficacy of continuous infusion of dexmedetomidine for procedural sedation of pediatric patients. There are few published reports of single dose dexmedetomidine for pediatric procedural sedation. We want to report on three pediatric patients who received single dose dexmedetomidine for procedural sedation. Methods: Case reports of pediatric patients who received intravenous dexmedetomidine for procedural sedation at Kentucky Children's Hospital. Results: Dexmedetomidine was administered as a single dose bolus of 1-3 mcg/kg over 10-15 minutes. In the clinical scenarios, effective sedation was achieved in order to perform MRI examinations and/or lumbar punctures. The only side effect related to administration was hypotension, which did not require intervention. Conclusion: Single dose dexmedetomidine appears to provide adequate procedural sedation for pediatric patients. Further studies are needed to confirm the effectiveness of this sedation regimen. Introduction Dexmedetomidine is a relatively new, α2-adrenergic receptor agonist with both sedative and analgesic properties. 1 It is classified as a sedative by the FDA and approved for sedation of adults in intensive care unit setting for up to 24 hours. 2 Several studies have evaluated the efficacy of dexmedetomidine as an agent for procedural sedation in the pediatric patient population. 3 4 5 6 In these studies, sedation was achieved by giving dexmedetomidine in an induction dose followed by a continuous infusion. A single intravenous dose of 0.5 mcg/kg has been used to decrease postoperative agitation and post anesthesia shivering. 4 A recent study suggested the efficacy of bolus dosing of dexmedetomidine, followed by IV infusion, in sedating children for CT scans. 7 There are no reports on the efficacy of single dose dexmedetomidine for procedural sedation. Methods Hospital records of patients undergoing procedural sedation with dexmedetomidine were obtained. Patients were identified from a log kept of all procedural sedations performed by the author. The following demographic data was obtained: age, weight, gender, and underlying medical condition. Information pertaining to dexmedetomidine included indication for administration, procedure performed, bolus dose given, and adverse effects that could be attributed to the medication. Vital signs were monitored per hospital sedation protocol, including blood pressure, heart rate, respiratory rate, and pulse oximetry, in five-minute intervals. Results The demographic data, indication for use, and dose administered is presented in Table 1. The following are brief descriptions of the individual cases. Patient 1 is a 6 year old male who presented with fever and progressive pain in hip area and difficulty ambulating. MRI of the pelvis and femur was obtained to assess for septic hip, osteomyelitis and/or abscess. Dexmedetomidine 20 mcg IV was given over 10 minutes. Appropriate sedation was achieved throughout the procedure. Vitals during procedure: heart rate 117-105; blood pressure126-99/91-40; respiratory rate 38-28; pulse oximetry 98-95% on room air. Patient was easily aroused at the end of the procedure with minimal stimulation. Total sedation time: 50 minutesPatient 2 is a 3 year old female with a history of seizure disorder who presented with worsening seizure activity unresponsive to current pharmacologic therapy. A lumbar puncture was requested as part of ongoing evaluation of her seizure disorder. Dexmedetomidine 30 mcg IV was given over 10-15 minutes. Appropriate level of sedation was obtained throughout the procedure. Vitals during procedure: heart rate111-106; blood pressure 85-69/50-36; pulse oximetry 98-97 % on room air; respiratory rate 38-28. Patient tolerated procedure well, and was easily aroused after lumbar puncture was finished. Total sedation time: 20 minutesPatient 3 is a 5 year old male who presented for evaluation of “starring spells”. MRI of the head and EEG were