Skip to main content

Advertisement

SpringerLink
Log in

Dexmedetomidine: Applications for the Pediatric Patient With Congenital Heart Disease

  • Review Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

This study aimed to provide a general description of the cardiovascular and hemodynamic effects of dexmedetomidine and an evidence-based review of the literature regarding its use in infants and children with congenital heart disease (CHD). A computerized bibliographic search of the literature on dexmedetomidine use in infants and children with CHD was performed. The cardiovascular 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. Both hypotension and hypertension also have been reported. The latter is related to peripheral α2B agonism leading to vasoconstriction. No adverse effects on the pulmonary vasculature have been noted even in patients with preexisting pulmonary hypertension. Although there are no direct effects on myocardial function, decreased cardiac output may result from changes in heart rate or increases in afterload. Although not currently Food and Drug Administration (FDA)-approved for the pediatric population, findings have shown dexmedetomidine to be effective in various clinical scenarios of patients with CHD including sedation during mechanical ventilation, prevention of procedure-related anxiety, prevention of emergence delirium and shivering after anesthesia, and treatment of withdrawal. Although dexmedetomidine may have limited utility for painful or invasive procedures, preliminary data suggest that the addition of ketamine to the regimen may offer benefits. When used during the perioperative period, additional benefits include blunting of the sympathetic stress response with a reduction of endogenous catecholamine release, a decrease in intraoperative anesthetic requirements, and a limitation of postoperative opioid requirements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baddigam K, Russo P, Russo J, Tobias JD (2005) Dexmedetomidine in the treatment of withdrawal syndromes in cardiothoracic surgery patients. J Intensive Care Med 20:118–123

    Article  PubMed  Google Scholar 

  2. Barton KP, Munoz R, Morell VO, Chrysostomou C (2008) Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease. Pediatr Crit Care Med 9:612–615

    Article  PubMed  Google Scholar 

  3. Belleville JP, Ward DS, Bloor BC, Maze M (1992) Effects of intravenous dexmedetomidine in humans: I. Sedation, ventilation, and metabolic rate. Anesthesiology 77:1125–1133

    Article  PubMed  CAS  Google Scholar 

  4. Berkenbosch JW, Tobias JD (2003) Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med 4:203–205

    Article  PubMed  Google Scholar 

  5. Berkenbosch JW, Wankum P, Tobias JD (2005) Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children. Pediatr Crit Care Med 6:435–439

    Article  PubMed  Google Scholar 

  6. Biccard BM, Goga S, de Beurs J (2008) Dexmedetomidine and cardiac protection for noncardiac surgery: a meta-analysis of randomised controlled trials. Anaesthesia 63:4–14

    Article  PubMed  CAS  Google Scholar 

  7. Bloor BC, Ward DS, Belleville JP, Maze M (1992) Effects of intravenous dexmedetomidine in humans: II. Hemodynamic changes. Anesthesiology 77:1134–1142

    Article  PubMed  CAS  Google Scholar 

  8. Bol CJG, Danhoff M, Stanski DR, Mandema JW (1997) Pharmacokinetic-pharmacodynamic characterization of the cardiovascular, hypnotic, EEG, and ventilatory responses to dexmedetomidine in the rat. J Pharm Exp Ther 283:1051–1058

    CAS  Google Scholar 

  9. Bozdogan N, Sener M, Caliskan E, Kocum A, Aribogan A (2008) A combination of ketamine and dexmedetomidine sedation with caudal anesthesia during incarcerated inguinal hernia repair in three high-risk infants. Pediatr Anesth 18:1009–1011

    Article  Google Scholar 

  10. But AK, Ozgul U, Erdil F, Gulhas N, Toprak HI, Durmus M, Ersoy MO (2006) The effects of preoperative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand 50:1207–1212

    Article  PubMed  CAS  Google Scholar 

  11. Chrysostomou C, Zeballos T (2005) Use of dexmedetomidine in a pediatric heart transplant patient. Pediatr Cardiol 26:651–654

    Article  PubMed  CAS  Google Scholar 

  12. Chrysostomou C, Di Filippo S, Manrique AM, Schmitt CG, Orr RA, Casta A, Suchoza E, Janosky J, Davis PJ, Munoz R (2006) Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med 7:126–131

    Article  PubMed  Google Scholar 

  13. Chrysostomou C, Beerman L, Shiderly D, Berry D, Morell VO, Munoz R (2008) Dexmedetomidine: a novel drug for the treatment of atrial and junctional tachyarrhythmias during the perioperative period for congenital cardiac surgery: a preliminary study. Anesth Analg 107:1514–1522

    Article  PubMed  CAS  Google Scholar 

  14. Chrysostomou C, Komarlu R, Lichtenstein S, Shiderly D, Arora G, Orr R, Wearden PD, Morell VO, Munoz R, Jooste EH (2011) Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease. Intensive Care Med 36:836–842

    Article  CAS  Google Scholar 

  15. Coughlan MG, Lee JG, Bosnjak ZJ, Schmeling WT, Kampine JP, Warltier DC (1992) Direct coronary and cerebral vascular responses to dexmedetomidine: significance of endogenous nitric oxide synthesis. Anesthesiology 77:998–1006

    Article  PubMed  CAS  Google Scholar 

  16. Dahmani S, Rouelle D, Gressens P, Mantz J (2005) Effects of dexmedetomidine on hippocampal focal adhesion kinase tyrosine phosphorylation in physiologic and ischemic conditions. Anesthesiology 103:969–977

    Article  PubMed  CAS  Google Scholar 

  17. Deutsch E, Tobias JD (2007) Hemodynamic and respiratory changes following dexmedetomidine administration during general anesthesia: sevoflurane vs desflurane. Pediatr Anesth 17:438–444

    Article  Google Scholar 

  18. Diaz SM, Rodarte A, Foley J, Capparelli EV (2007) Pharmacokinetics of dexmedetomidine in postsurgical pediatric intensive care unit patients: a preliminary study. Pediatr Crit Care Med 8:419–424

    Article  PubMed  Google Scholar 

  19. Doufas AG, Lin CM, Suleman MI, Liem EB, Lenhardt R, Morioka N, Akca O, Shah YM, Bjorksten AR, Sessler DI (2003) Dexmedetomidine and meperidine actively reduce the shivering threshold in humans. Stroke 34:1218–1223

    Article  PubMed  CAS  Google Scholar 

  20. Dyck JB, Shafer SL (1993) Dexmedetomidine pharmacokinetics and pharmacodynamics. Anesth Pharm Rev 1:238–245

    CAS  Google Scholar 

  21. Easley RB, Brady KM, Tobias JD (2007) Dexmedetomidine for the treatment of postanesthesia shivering in children. Paediatr Anaesth 17:341–346

    Article  Google Scholar 

  22. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD (2000) The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 93:382–394

    Article  PubMed  CAS  Google Scholar 

  23. Engelhard K, Werner C, Kaspar S, Möllenberg O, Blobner M, Bachl M, Kochs E (2002) Effect of the α2-agonist dexmedetomidine on cerebral neurotransmitter concentrations during cerebral ischemia in rats. Anesthesiology 96:450–457

    Article  PubMed  CAS  Google Scholar 

  24. Finkel JC, Elrefai A (2004) The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant. Anesth Analg 98:1658–1659

    Article  PubMed  Google Scholar 

  25. Finkel JC, Johnson YJ, Quezado YMN (2005) The use of dexmedetomidine to facilitate acute discontinuation of opioids alter cardiac transplantation in children. Crit Care Med 33:2110–2112

    Article  PubMed  CAS  Google Scholar 

  26. Furst SR, Weinger MB (1990) Dexmedetomidine, a selective α2-agonist, does not potentiate the cardiorespiratory depression of alfentanil in the rat. Anesthesiology 72:882–888

    Article  PubMed  CAS  Google Scholar 

  27. Guler G, Akin A, Tosun Z, Ors S, Esmaoglu A, Boyaci A (2005) Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Pediatr Anesth 15:762–766

    Article  Google Scholar 

  28. Guo H, Takahashi S, Cho S, Hara T, Tomiyasu S, Sumikawa K (2005) The effects of dexmedetomidine on left ventricular function during hypoxia and reoxygenation in isolated rat hearts. Anesth Analg 100:629–635

    Article  PubMed  CAS  Google Scholar 

  29. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ (2000) Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg 90:699–705

    Article  PubMed  CAS  Google Scholar 

  30. Hammer GB, Drover DR, Jackson E (2008) The effects of dexmedetomidine on cardiac electrophysiology in children. Anesth Analg 106:79–83

    Article  PubMed  CAS  Google Scholar 

  31. Hanafy MA, El-Zahaby HM, Swellam AM (2004) The effect of dexmedetomidine on the emergence agitation associated with desflurane anaesthesia in children. Egypt J Anaesth 20:135–140

    CAS  Google Scholar 

  32. Heusch G, Baumgart D, Camici P, Chilian W, Gregorini L, Hess O, Indolfi C, Rimoldi O (2000) Alpha-adrenergic coronary vasoconstriction and myocardial ischemia in humans. Circulation 101:689–694

    PubMed  CAS  Google Scholar 

  33. Hoffman WE, Kochs E, Werner C, Thomas C, Albrecht RF (1991) Dexmedetomidine improves neurologic outcome from incomplete ischemia in the rat: reversal by the α2-adrenergic antagonist atipamezole. Anesthesiology 75:328–332

    Article  PubMed  CAS  Google Scholar 

  34. Honey BL, Harrison DL, Gormley AK, Johnson PN (2010) Evaluation of adverse events noted in children receiving continuous infusions of dexmedetomidine in the intensive care unit. J Pediatr Pharm Ther 15:30–37

    Google Scholar 

  35. Hosokawa K, Shime N, Kato Y, Taniguchi A, Maeda Y, Miyazaki T, Hashimoto S (2010) Dexmedetomidine sedation in children after cardiac surgery. Pediatr Crit Care Med 11:39–43

    Article  PubMed  Google Scholar 

  36. Hsu YW, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, Young CC, Wright DR, Macleod DB, Somma J (2004) Dexmedetomidine pharmacodynamics: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 101:1066–1076

    Article  PubMed  CAS  Google Scholar 

  37. Ibacache ME, Muñoz HR, Brandes V, Morales AL (2004) Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg 98:60–63

    Article  PubMed  CAS  Google Scholar 

  38. Ingersoll-Weng E, Manecke GR, Thistlethwaite PA (2004) Dexmedetomidine and cardiac arrest. Anesthesiology 100:738–739

    Article  PubMed  Google Scholar 

  39. Isik B, Arslan M, Tunga AD, Kurtipek O (2006) Dexmedetomidine decreases emergence agitation in pediatric patients after sevoflurane anesthesia without surgery. Pediatr Anesth 16:748–753

    Article  Google Scholar 

  40. Jaatinen P, Riihioja P, Haapalinna A, Heinonen E, Kiianmaa K, Hervonen A (1995) Prevention of ethanol-induced sympathetic overactivity and degeneration by dexmedetomidine. Alcohol 12:439–446

    Article  PubMed  CAS  Google Scholar 

  41. Jalonen J, Halkola L, Kuttila K, Perttilä J, Rajalin A, Savunen T, Scheinin M, Valtonen M (1995) Effects of dexmedetomidine on coronary hemodynamics and myocardial oxygen balance. J Cardiothorac Vasc Anesth 9:519–524

    Article  PubMed  CAS  Google Scholar 

  42. Jalonen J, Hynynen M, Kuitunen A, Heikkilä H, Perttilä J, Salmenperä M, Valtonen M, Aantaa R, Kallio A (1997) Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 86:331–345

    Article  PubMed  CAS  Google Scholar 

  43. Jooste EH, Muhly WT, Ibinson JW, Suresh T, Damian D, Phadke A, Callahan P, Miller S, Feingold B, Lichtenstein SE, Cain JG, Chrysostomou C, Davis PJ (2010) Acute hemodynamic changes after rapid intravenous bolus dosing of dexmedetomidine in pediatric heart transplant patients undergoing cardiac catheterization. Anesth Analg 111:1490–1496

    Article  PubMed  CAS  Google Scholar 

  44. Kalyanaraman M, Costello JL, Starr JP (2007) Use of dexmedetomidine in patients with trisomy 21 after cardiac surgery. Pediatr Cardiol 28:396–399

    Article  PubMed  CAS  Google Scholar 

  45. Kamibayashi T, Mammoto T, Hayashi Y, Yamatodani A, Takada K, Sasaki S, Yoshiya I (1995) Further characterization of the receptor mechanism involved in the antidysrhythmic effect of dexmedetomidine on halothane/epinephrine dysrhythmias in dogs. Anesthesiology 83:1082–1089

    Article  PubMed  CAS  Google Scholar 

  46. Karlsson BR, Forsman M, Roald OK, Heier MS, Steen PA (1990) Effect of dexmedetomidine, a selective and potent α2-agonist, on cerebral blood flow and oxygen consumption during halothane anesthesia in dogs. Anesth Analg 71:125–129

    Article  PubMed  CAS  Google Scholar 

  47. Kästner SB, Kull S, Kutter AP, Boller J, Bettschart-Wolfensberger R, Huhtinen MK (2005) Cardiopulmonary effects of dexmedetomidine in sevoflurane-anesthetized sheep with and without nitric oxide inhalation. Am J Vet Res 66:1496–1502

    Article  PubMed  Google Scholar 

  48. Klamt JG, de Andrade Vicente WV, Garcia LV, Ferreira CA (2010) Effects of dexmedetomidine-fentanyl infusion on blood pressure and heart rate during cardiac surgery in children. Anesth Res Pract

  49. Koroglu A, Demirbilek S, Teksan H, Sagir O, But AK, Ersoy MO (2005) Sedative, hemodynamic, and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth 94:821–824

    Article  PubMed  CAS  Google Scholar 

  50. Kuhmonen J, Pokorný J, Miettinen R, Haapalinna A, Jolkkonen J, Riekkinen P Sr, Sivenius J (1997) Neuroprotective effects of dexmedetomidine in the gerbil hippocampus after transient global ischemia. Anesthesiology 87:371–377

    Article  PubMed  CAS  Google Scholar 

  51. Kuhmonen J, Haapalinna A, Sivenius J (2001) Effects of dexmedetomidine after transient and permanent occlusion of the middle cerebral artery in the rat. J Neural Transm 108:261–271

    Article  PubMed  CAS  Google Scholar 

  52. Laudenbach V, Mantz J, Lagercrantz H, Desmonts JM, Evrard P, Gressens P (2002) Effects of α2-adrenoceptor agonists on perinatal excitotoxic brain injury: comparison of clonidine and dexmedetomidine. Anesthesiology 96:134–141

    Article  PubMed  CAS  Google Scholar 

  53. Lazol JP, Lichtenstein SE, Jooste EH, Shiderly D, Kudchadker NA, Tatum GH, Orr RA, Wearden PD, Morell VO, Munoz RA, Chrysostomou C (2010) Effect of dexmedetomidine on pulmonary artery pressure after congenital cardiac surgery: a pilot study. Pediatr Crit Care Med 11:589–592

    Article  PubMed  Google Scholar 

  54. Levanen J, Makela ML, Scheinin H (1995) Dexmedetomidine premedication attenuates ketamine-induced cardiostimulatory effects and postanesthetic delirium. Anesthesiology 82:1117–1125

    Article  PubMed  CAS  Google Scholar 

  55. Maccioli GA (2003) Dexmedetomidine to facilitate drug withdrawal. Anesthesiology 98:575–577

    Article  PubMed  Google Scholar 

  56. Mahmoud M, Gunter J, Donnelly LF, Wang Y, Nick TG, Sadhasivam S (2009) A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children. Anesth Analg 109:745–753

    Article  PubMed  CAS  Google Scholar 

  57. Mason KP, Zgleszewski SE, Dearden JL, Dumont RS, Pirich MA, Stark CD, D’ Angelo P, Macpherson S, Fontaine PJ, Connor L, Zurakowski D (2006) Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth Analg 103:57–62

    Article  PubMed  CAS  Google Scholar 

  58. Mester R, Easley RB, Brady KM, Chilson K, Tobias JD (2008) Monitored anesthesia care with a combination of ketamine and dexmedetomidine during cardiac catheterization. Am J Ther 15:24–30

    Article  PubMed  Google Scholar 

  59. Mukhtar AM, Obayah EM, Hassona AM (2006) The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg 103:52–56

    Article  PubMed  CAS  Google Scholar 

  60. Multz AS (2003) Prolonged dexmedetomidine infusion as an adjunct in treating sedation-induced withdrawal. Anesth Analg 96:1054–1055

    Article  PubMed  Google Scholar 

  61. Munro HM, Tirotta CF, Felix DE, Lagueruela RG, Madril DR, Zahn EM, Nykanen DG (2007) Initial experience with dexmedetomidine for diagnostic and interventional cardiac catheterization in children. Pediatr Anesth 17:109–112

    Article  Google Scholar 

  62. Munro HM, Felix DE, Nykanen DG (2009) Dexmedetomidine/ketamine for diagnostic cardiac catheterization in a child with idiopathic pulmonary hypertension. J Clin Anesth 21:435–438

    Article  PubMed  CAS  Google Scholar 

  63. Naguib A, McKee C, Philips A, Tobias JD (2011) Dexmedetomidine as the primary anesthetic agent during cardiac surgery in an infant with a family history of malignant hyperthermia. Saudi J Anaesth (in press)

  64. Nathan AT, Marino BS, Hanna B, Nicholson SC (2008) Novel use of dexmedetomidine in a patient with pulmonary hypertension. Pediatr Anaesth 18:782–784

    Article  Google Scholar 

  65. Nguyen D, Abdul-Rasool I, Ward D, Hsieh J, Kobayashi D, Hadlock S, Singer F, Bloor B (1992) Ventilatory effects of dexmedetomidine, atipamezol, and isoflurane in dogs. Anesthesiology 76:573–579

    Article  PubMed  CAS  Google Scholar 

  66. Ngwenyama NE, Anderson J, Hoernschemeyer DG, Tobias JD (2008) Effects of dexmedetomidine on propofol and remifentanil infusion rates during total intravenous anesthesia for spine surgery in adolescents. Pediatr Anesth 18:1190–1195

    Google Scholar 

  67. Nishida T, Nishimura M, Kagawa K, Hayashi Y, Mashimo T (2002) The effects of dexmedetomidine on the ventilatory response to hypercapnia in rabbits. Intensive Care Med 28:969–975

    Article  PubMed  Google Scholar 

  68. Oliver MF, Goldman L, Julian DG, Holme I (1999) Effect of mivazerol on perioperative cardiac complications during noncardiac surgery in patients with coronary artery disease: the European mivazerol trial (EMIT). Anesthesiology 91:951–961

    Article  PubMed  CAS  Google Scholar 

  69. Peden CJ, Cloote AH, Stratford N, Prys-Roberts C (2001) The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia 56:408–413

    Article  PubMed  CAS  Google Scholar 

  70. Petroz GC, Sikich N, James M, van Dyk H, Shafer SL, Schily M, Lerman J (2006) A phase 1, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology 105:1098–1110

    Article  PubMed  CAS  Google Scholar 

  71. Potts AL, Warman GR, Anderson BJ (2008) Dexmedetomidine disposition in children: a population analysis. Pediatr Anesth 18:722–730

    Article  Google Scholar 

  72. Potts AL, Anderson BJ, Warman GR, Lerman J, Diaz SM, Vilo S (2009) Dexmedetomidine pharmacokinetics in pediatric intensive care: a pooled analysis. Pediatr Anesth 19:1119–1129

    Article  Google Scholar 

  73. Potts AL, Anderson BJ, Holford NH, Vu TC, Warman GR (2010) Dexmedetomidine hemodynamics in children after cardiac surgery. Pediatr Anesth 20:425–433

    Article  Google Scholar 

  74. Prielipp RC, Wall MH, Tobin JR, Groban L, Cannon MA, Fahey FH, Gage HD, Stump DA, James RL, Bennett J, Butterworth J (2002) Dexmedetomidine-induced sedation in volunteers decreases regional and global cerebral blood flow. Anesth Analg 95:1052–1059

    PubMed  CAS  Google Scholar 

  75. Riihioja P, Jaatinen P, Oksanen H, Haapalinna A, Heinonen E, Hervonen A (1997) Dexmedetomidine, diazepam, and propranolol in the treatment of alcohol withdrawal symptoms in the rat. Alcohol Clin Exp Res 21:804–808

    Article  PubMed  CAS  Google Scholar 

  76. Riihioja P, Jaatinen P, Oksanen H, Haapalinna A, Heinonen E, Hervonen A (1997) Dexmedetomidine alleviates ethanol withdrawal symptoms in the rat. Alcohol 14:537–544

    Article  PubMed  CAS  Google Scholar 

  77. Riihioja P, Jaatinen P, Haapalinna A, Kiianmaa K, Hervonen A (1999) Effects of dexmedetomidine on rat loceus coeruleus and ethanol withdrawal symptoms during intermittent ethanol exposure. Alcohol Clin Exp Res 23:432–438

    Article  PubMed  CAS  Google Scholar 

  78. Roekaerts PMH, Prinzen FW, De Lange S (1996) Beneficial effects of dexmedetomidine on ischaemic myocardium of anaesthetized dogs. Br J Anaesth 77:427–429

    PubMed  CAS  Google Scholar 

  79. Ruesch S, Levy JH (2002) Treatment of persistent tachycardia with dexmedetomidine during off-pump cardiac surgery. Anesth Analg 95:316–318

    PubMed  Google Scholar 

  80. Salmenpera MT, Szlam F, Hug CC Jr (1993) Anesthetic and hemodynamic interactions of dexmedetomidine and fentanyl in dogs. Anesthesiology 78:813–820

    Article  Google Scholar 

  81. Sanders RD, Xu J, Shu Y, Januszewski A, Halder S, Fidalgo A, Sun P, Hossain M, Ma D, Maze M (2009) Dexmedetomidine attenuates isoflurane-induced neurocognitive impairment in neonatal rats. Anesthesiology 110:1077–1085

    Article  PubMed  CAS  Google Scholar 

  82. Sanders RD, Sun P, Patel S, Li M, Maze M, Ma D (2010) Dexmedetomidine provides cortical neuroprotection: impact on anaesthetic-induced neuroapoptosis in the rat developing brain. Acta Anaesthesiol Scand 54:710–716

    Article  PubMed  CAS  Google Scholar 

  83. Scheinin H, Jaakola ML, Sjövall S, Ali-Melkkilä T, Kaukinen S, Turunen J, Kanto J (1993) Intramuscular dexmedetomidine as premedication for general anesthesia: a comparative multicenter study. Anesthesiology 78:1065–1075

    Article  PubMed  CAS  Google Scholar 

  84. Senzaki H, Ishido H, Iwamoto Y, Taketazu M, Kobayashi T, Katogi T, Kyo S (2008) Sedation of hypercyanotic spells in a neonate with tetralogy of Fallot using dexmedetomidine. J Pediatria 84:377–380

    Article  Google Scholar 

  85. Shinohara H, Hirota K, Sato M, Kakuyama M, Fukuda K (2010) Monitored anesthesia care with dexmedetomidine of a patient with severe pulmonary arterial hypertension for inguinal hernioplasty. J Anesth 24:611–613

    Article  PubMed  Google Scholar 

  86. Shukry M, Clyde MC, Kalarickal PL, Ramadhyani U (2005) Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia. Pediatr Anesth 15:1098–1104

    Article  Google Scholar 

  87. Sichrovsky TC, Mittal S, Steinberg JS (2008) Dexmedetomidine sedation leading to refractory cardiogenic shock. Anesth Analg 106:1784–1786

    Article  PubMed  CAS  Google Scholar 

  88. Snapir A, Heinonen P, Tuomainen TP, Alhopuro P, Karvonen MK, Lakka TA, Nyyssönen K, Salonen R, Kauhanen J, Valkonen VP, Pesonen U, Koulu M, Scheinin M, Salonen JT (2001) An insertion/deletion polymorphism in the alpha2B-adrenergic receptor gene is a novel genetic risk factor for acute coronary events. J Am Coll Cardiol 37:1516–1522

    Article  PubMed  CAS  Google Scholar 

  89. Snapir A, Mikkelsson J, Perola M, Penttilä A, Scheinin M, Karhunen PJ (2003) Variation in the alpha2B-adrenoceptor gene as a risk factor for prehospital fatal myocardial infarction and sudden cardiac death. J Am Coll Cardiol 41:190–194

    Article  PubMed  CAS  Google Scholar 

  90. Su F, Nicolson SC, Gastonguay MR, Barrett JS, Adamson PC, Kang DS, Godinez RI, Zuppa AF (2010) Population pharmacokinetics of dexmedetomidine in infants following open heart surgery. Anesth Analg 110:1383–1392

    Article  PubMed  CAS  Google Scholar 

  91. Talke P, Li J, Jain U, Leung J, Drasner K, Hollenberg M, Mangano DT (1995) Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The study of perioperative ischemia research group. Anesthesiology 82:620–633

    Article  PubMed  CAS  Google Scholar 

  92. Talke P, Richardson CA, Scheinin M, Fisher DM (1997) Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg 85:1136–1142

    PubMed  CAS  Google Scholar 

  93. Talke P, Chen R, Thomas B, Aggarwall A, Gottlieb A, Thorborg P, Heard S, Cheung A, Son SL, Kallio A (2000) The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 90:834–839

    Article  PubMed  CAS  Google Scholar 

  94. Tobias JD (2006) Dexmedetomidine to treat opioid withdrawal in infants and children following prolonged sedation in the pediatric ICU. J Opioid Manage 2:201–206

    Google Scholar 

  95. Tobias JD (2007) Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med 8:115–131

    Article  PubMed  Google Scholar 

  96. Tobias JD (2008) Bradycardia during dexmedetomidine and therapeutic hypothermia. J Intensive Care Med 23:403–408

    Article  PubMed  Google Scholar 

  97. Tobias JD, Berkenbosch JW (2004) Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J 97:451–455

    Article  PubMed  Google Scholar 

  98. Tobin JR, Shafer SL, Davis PJ (2006) Pediatric research and scholarship: another Gordian knot? Anesth Analg 103:43–47

    Article  PubMed  Google Scholar 

  99. Tokuhira N, Atagi K, Shimaoka H, Ujiro A, Otsuka Y, Ramsay M (2009) Dexmedetomidine sedation for pediatric post-Fontan procedure patients. Pediatr Crit Care Med 10:207–212

    Article  PubMed  Google Scholar 

  100. Tosun Z, Akin A, Guler G, Esmaoglu A, Boyaci A (2006) Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth 20:515–519

    Article  PubMed  CAS  Google Scholar 

  101. Venn RM, Karol MD, Grounds RM (2002) Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care. Br J Anaesth 88:669–675

    Article  PubMed  CAS  Google Scholar 

  102. Vilo S, Rautiainen P, Kaisti K, Aantaa R, Scheinin M, Manner T, Olkkola KT (2008) Pharmacokinetics of intravenous dexmedetomidine in children under 11 years of age. Br J Anaesth 100:697–700

    Article  PubMed  CAS  Google Scholar 

  103. Virtanen R, Savola JM, Saano V, Nyman L (1998) Characterization of selectivity, specificity, and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol 150:9–14

    Article  Google Scholar 

  104. Weber MD, Thammasitboon S, Rosen DA (2008) Acute discontinuation syndrome from dexmedetomidine after protracted use in a pediatric patient. Pediatr Anesth 18:87–88

    Article  Google Scholar 

  105. Willigers HM, Prinzen FW, Roekaerts PM, de Lange S, Durieux ME (2003) Dexmedetomidine decreases perioperative myocardial lactate release in dogs. Anesth Analg 96:657–664

    Article  PubMed  CAS  Google Scholar 

  106. Young ET (2005) Dexmedetomidine sedation in a pediatric cardiac patient scheduled for MRI. Can J Anaesth 52:730–732

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and The Heart Center, Nationwide Children’s Hospital and Ohio State University, Columbus, OH, 43205, USA

    Joseph D. Tobias & Aymen Naguib

  2. Division of Pediatric Cardiac Critical Care, Arkansas Children’s Hospital, Little Rock, AR, USA

    Punkaj Gupta

  3. Department of Pediatrics, Divisions of Pediatric Cardiology and Pediatric Critical Care, Nationwide Children’s Hospital and Ohio State University, Columbus, OH, 43205, USA

    Andrew R. Yates

Authors
  1. Joseph D. Tobias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Punkaj Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aymen Naguib
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew R. Yates
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joseph D. Tobias.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tobias, J.D., Gupta, P., Naguib, A. et al. Dexmedetomidine: Applications for the Pediatric Patient With Congenital Heart Disease. Pediatr Cardiol 32, 1075–1087 (2011). https://doi.org/10.1007/s00246-011-0092-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-011-0092-8

Keywords

Search

Navigation