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Alpha-agonists in Pediatric Procedural Sedation

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Sedation and Analgesia for the Pediatric Intensivist
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Abstract

Dexmedetomidine (DEX), a central alpha-2-agonist, is being increasingly used in outpatient procedural sedation. Recent concerns about the time-honored hypnotic chloral hydrate’s carcinogenicity, genotoxicity, and more importantly lack of availability in the US market have led to DEX as a viable alternative to chloral hydrate in procedural sedation both as an intravenous (IV) medication and an intranasal medication.

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References

  1. Zhang H, Yan X, Wang DG, et al. Dexmedetomidine relieves formaldehyde-induced pain in rats through both alpha2 adrenoceptor and imidazoline receptor. Biomed Pharmacother. 2017;90:914–20. https://doi.org/10.1016/j.biopha.2017.04.047.

    Article  CAS  Google Scholar 

  2. Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology. 1992;77(6):1134–42. https://doi.org/10.1097/00000542-199212000-00014.

    Article  CAS  Google Scholar 

  3. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77(6):1125–33. https://doi.org/10.1097/00000542-199212000-00013.

    Article  CAS  Google Scholar 

  4. Blaine Easley R, Brady KM, Tobias JD. Dexmedetomidine for the treatment of postanesthesia shivering in children. Paediatr Anaesth. 2007;17(4):341–6. https://doi.org/10.1111/j.1460-9592.2006.02100.x.

    Article  CAS  Google Scholar 

  5. Mahmoud M, Radhakrishman R, Gunter J, et al. Effect of increasing depth of dexmedetomidine anesthesia on upper airway morphology in children. Paediatr Anaesth. 2010;20(6):506–15. https://doi.org/10.1111/j.1460-9592.2010.03311.x.

    Article  Google Scholar 

  6. Lodenius A, Maddison KJ, Lawther BK, et al. Upper airway collapsibility during dexmedetomidine and propofol sedation in healthy volunteers: a nonblinded randomized crossover study. Anesthesiology. 2019;131(5):962–73. https://doi.org/10.1097/ALN.0000000000002883.

    Article  CAS  Google Scholar 

  7. Perez-Zoghbi JF, Zhu W, Grafe MR, Brambrink AM. Dexmedetomidine-mediated neuroprotection against sevoflurane-induced neurotoxicity extends to several brain regions in neonatal rats. Br J Anaesth. 2017;119(3):506–16. https://doi.org/10.1093/bja/aex222.

    Article  CAS  Google Scholar 

  8. Sato M, Shirakami G, Tazuke-Nishimura M, Matsuura S, Tanimoto K, Fukuda K. Effect of single-dose dexmedetomidine on emergence agitation and recovery profiles after sevoflurane anesthesia in pediatric ambulatory surgery. J Anesth. 2010;24(5):675–82. https://doi.org/10.1007/s00540-010-0976-4.

    Article  Google Scholar 

  9. Petroz GC, Sikich N, James M, et al. A phase I, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology. 2006;105(6):1098–110. https://doi.org/10.1097/00000542-200612000-00009.

    Article  CAS  Google Scholar 

  10. Anttila M, Penttila J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br J Clin Pharmacol. 2003;56(6):691–3. https://doi.org/10.1046/j.1365-2125.2003.01944.x.

    Article  Google Scholar 

  11. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59(2):263–8. https://doi.org/10.2165/00003495-200059020-00012; discussion 269–270.

    Article  CAS  Google Scholar 

  12. Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth. 2015;115(2):171–82. https://doi.org/10.1093/bja/aev226.

    Article  CAS  Google Scholar 

  13. Mason KP, Zurakowski D, Zgleszewski S, Prescilla R, Fontaine PJ, Dinardo JA. Incidence and predictors of hypertension during high-dose dexmedetomidine sedation for pediatric MRI. Paediatr Anaesth. 2010;20(6):516–23. https://doi.org/10.1111/j.1460-9592.2010.03299.x.

    Article  Google Scholar 

  14. Sulton C, McCracken C, Simon HK, et al. Pediatric procedural sedation using dexmedetomidine: a report from the Pediatric Sedation Research Consortium. Hosp Pediatr. 2016;6(9):536–44. https://doi.org/10.1542/hpeds.2015-0280.

    Article  Google Scholar 

  15. Mason KP, Zgleszewski S, Forman RE, Stark C, DiNardo JA. An exaggerated hypertensive response to glycopyrrolate therapy for bradycardia associated with high-dose dexmedetomidine. Anesth Analg. 2009;108(3):906–8. https://doi.org/10.1213/ane.0b013e3181948a6f.

    Article  Google Scholar 

  16. Mason KP, O’Mahony E, Zurakowski D, Libenson MH. Effects of dexmedetomidine sedation on the EEG in children. Paediatr Anaesth. 2009;19(12):1175–83. https://doi.org/10.1111/j.1460-9592.2009.03160.x.

    Article  Google Scholar 

  17. Lubisch N, Roskos R, Berkenbosch JW. Dexmedetomidine for procedural sedation in children with autism and other behavior disorders. Pediatr Neurol. 2009;41(2):88–94. https://doi.org/10.1016/j.pediatrneurol.2009.02.006.

    Article  Google Scholar 

  18. Kamat PP, McCracken CE, Gillespie SE, et al. Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatr Crit Care Med. 2015;16(1):11–20. https://doi.org/10.1097/PCC.0000000000000273.

    Article  Google Scholar 

  19. Berkenbosch JW, Wankum PC, Tobias JD. Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children. Pediatr Crit Care Med. 2005;6(4):435–9. https://doi.org/10.1097/01.PCC.0000163680.50087.93; quiz 440.

    Article  Google Scholar 

  20. Mason KP, Robinson F, Fontaine P, Prescilla R. Dexmedetomidine offers an option for safe and effective sedation for nuclear medicine imaging in children. Radiology. 2013;267(3):911–7. https://doi.org/10.1148/radiol.13121232.

    Article  Google Scholar 

  21. Mason KP. Sedation trends in the 21st century: the transition to dexmedetomidine for radiological imaging studies. Paediatr Anaesth. 2010;20(3):265–72. https://doi.org/10.1111/j.1460-9592.2009.03224.x.

    Article  Google Scholar 

  22. Tobias JD. Dexmedetomidine and ketamine: an effective alternative for procedural sedation? Pediatr Crit Care Med. 2012;13(4):423–7. https://doi.org/10.1097/PCC.0b013e318238b81c.

    Article  Google Scholar 

  23. Mason KP, Zurakowski D, Zgleszewski SE, et al. High dose dexmedetomidine as the sole sedative for pediatric MRI. Paediatr Anaesth. 2008;18(5):403–11. https://doi.org/10.1111/j.1460-9592.2008.02468.x.

    Article  Google Scholar 

  24. Mason KP, Lubisch NB, Robinson F, Roskos R. Intramuscular dexmedetomidine sedation for pediatric MRI and CT. AJR Am J Roentgenol. 2011;197(3):720–5. https://doi.org/10.2214/AJR.10.6134.

    Article  Google Scholar 

  25. Cozzi G, Norbedo S, Barbi E. Intranasal dexmedetomidine for procedural sedation in children, a suitable alternative to chloral hydrate. Paediatr Drugs. 2017;19(2):107–11. https://doi.org/10.1007/s40272-017-0217-5.

    Article  Google Scholar 

  26. Sulton C, Kamat P, Mallory M, Reynolds J. The use of intranasal dexmedetomidine and midazolam for sedated magnetic resonance imaging in children: a report from the Pediatric Sedation Research Consortium. Pediatr Emerg Care. 2017. https://doi.org/10.1097/PEC.0000000000001199.

  27. Lewis J, Bailey CR. Intranasal dexmedetomidine for sedation in children; a review. J Perioper Pract. 2019:1750458919854885. https://doi.org/10.1177/1750458919854885.

  28. Jun JH, Kim KN, Kim JY, Song SM. The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis. Can J Anaesth. 2017;64(9):947–61. https://doi.org/10.1007/s12630-017-0917-x.

    Article  Google Scholar 

  29. Mondardini MC, Amigoni A, Cortellazzi P, et al. Intranasal dexmedetomidine in pediatrics: update of current knowledge. Minerva Anestesiol. 2019. https://doi.org/10.23736/S0375-9393.19.13820-5.

  30. Olgun G, Ali MH. Use of intranasal dexmedetomidine as a solo sedative for MRI of infants. Hosp Pediatr. 2018. https://doi.org/10.1542/hpeds.2017-0120.

  31. Boriosi JP, Eickhoff JC, Klein KB, Hollman GA. A retrospective comparison of propofol alone to propofol in combination with dexmedetomidine for pediatric 3T MRI sedation. Paediatr Anaesth. 2017;27(1):52–9. https://doi.org/10.1111/pan.13041.

    Article  Google Scholar 

  32. Barton KP, Munoz R, Morell VO, Chrysostomou C. Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease. Pediatr Crit Care Med. 2008;9(6):612–5. https://doi.org/10.1097/PCC.0b013e31818d320d.

    Article  Google Scholar 

  33. Mohite V, Baliga S, Thosar N, Rathi N. Role of dexmedetomidine in pediatric dental sedation. J Dent Anesth Pain Med. 2019;19(2):83–90. https://doi.org/10.17245/jdapm.2019.19.2.83.

    Article  Google Scholar 

  34. Sago T, Shiiba S, Ando E, et al. Sedation with a combination of dexmedetomidine and midazolam for pediatric dental surgery. Anesth Prog. 2018;65(2):124–6. https://doi.org/10.2344/anpr-65-03-14.

    Article  Google Scholar 

  35. Muller S, Borowics SM, Fortis EA, et al. Clinical efficacy of dexmedetomidine alone is less than propofol for conscious sedation during ERCP. Gastrointest Endosc. 2008;67(4):651–9. https://doi.org/10.1016/j.gie.2007.09.041.

    Article  Google Scholar 

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Kamat, P.P. (2021). Alpha-agonists in Pediatric Procedural Sedation. In: Kamat, P.P., Berkenbosch, J.W. (eds) Sedation and Analgesia for the Pediatric Intensivist. Springer, Cham. https://doi.org/10.1007/978-3-030-52555-2_29

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  • DOI: https://doi.org/10.1007/978-3-030-52555-2_29

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  • Online ISBN: 978-3-030-52555-2

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