Aims & Objectives:
Dexmedetomidine (DEX) is currently approved for sedation in adult intensive care patients, with emerging potential to be used in the pediatric critical care setting. Until now, indications and safety for prolonged sedation in children has not been rigorously evaluated.
Two independent investigators searched PubMed and Cochrane Library to identify studies reporting prolonged DEX sedation (mean/median time >24 hours) in children <18 years. We excluded case reports, narrative reviews and tudies including only neonates or premature babies.
Of the 1156 studies found, 31 met the inclusion criteria, involving a total of 3342 patients. The majority of studies were monocentric (94%) and retrospective (87%); there were no randomized trials. Minimum and maximum infusion dosages varied from 0.1–0.5 mcg/kg/h and 0.45–2.5 mcg/kg/h respectively, while mean/median duration range was 25–540 hours. Loading dose was reported in 5 studies, with a range of 0.5–1 mcg/kg. Mode of weaning was reported in 9 studies, and weaning time was described in 5 studies (range 9–96 hours). Main reported side-effects were bradycardia (range 0–56%) and hypotension (range 0–59%), with 3 studies reporting time of onset. Less than half of the studies reported withdrawal symptoms (39%) and rebound effects (35%), which were present in 0–27% and 0–24% of patients respectively.
There was a paucity of quality of data regarding DEX prolonged sedation in children. DEX indications were varied and there was no consensus on duration, dose or weaning protocols. There also needs to be improved reporting on side-effects, their time of onset and withdrawal and rebound symptoms.