Experience with the dexmedetomidine for sedation in pediatric neurosurgery in the early postoperative period

Keywords: dexmedetomidine; α2-agonist; postoperative sedation; pediatric neurosurgery.

Abstract

Objective ‒ to maintain the adequate sedation and analgesia without respiratory depression in children up to 4 years old with spinal cord pathology in early postoperative period (first 3 days) in inpatient department; to decrease digestive system motor function depression; to exclude aspiration possibility; to start early children’s natural feeding in postoperative period.
Materials and methods. From October 2019 to January 2020 dexmedetomidine sedation was performed by the prolonged infusion administration to 10 children (6 children aged 6 month to 1 year and 4 children up to 4 years) with spinal cord and vertebral pathology (spina bifida, meningomyelocele, myelocele, teratoma, lipoma of lumbar spine) in early postoperative period at intensive observation ward of neurosurgical department. During the first three days after the surgery and dexmedetomidine prescription the vital functions monitoring was being performed for 24 hours. Arterial blood pressure, heart rate, blood saturation have been scheduled by one of the parents. The immediate access to oxygen and parent’s permission for using this sedation method were the obligatory requirements.
Results. The appropriate sedation target was achieved after the dexmedetomidine prescription for the children with the spinal cord and vertebral pathology in early postoperative period at intensive observation ward of neurosurgical department; the dosage of opioid analgesics was successfully decreased by 50 %. The respiratory depression was not observed. The blood pressure and bradycardia were not haemodynamically significant. Swallowing reflex was saved, which led to early physiological nutrition and excluded aspiration risk. The following transfer of patients after the surgery to the neurosurgical department bypassing ICU reduced the financial expenditure of the hospital.
Conclusions. Dexmedetomidine provides with the adequate sedation in early postoperative period and can be recommended for the usage in children with the spinal cord and vertebral pathology as the safest medication due to minimal cardio-respiratory complications during moderately prolonged prescribed period.

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References

Joseph L. The use of dexmedetomidine in pediatric anesthesia. Journal of the Med. Ass. of Atlanta. February 15, 2017.

Shukry M, Kennedy K. Dexmedetomidine as a total intravenous anesthetic in infants. Paediatr Anaesth. 2007;17:581-3. doi: 10.1111/j.1460-9592.2006.02171.x.

Munro H, Tirotta C, Felix D et al. Initial experience with dexmedetomidine for diagnostic and interventional cardiac catheterization in children. Paediatr Anaesth. 2007;17:109-12. doi: 10.1111/j.1460-9592.2006.02031.x.

Ard J, Doyle W, Bekker A. Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol. 2003;15:263-66. doi: 10.1097/00008506-200307000-00015.

Aryan HE, Box KW, Ibrahim D, Desiraju U, Ames CP. Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain Inj. 2006;20:791-8. doi: 10.1080/02699050600789447

Bekker AY, Kaufman B, Samir H, Doyle W. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg. 2001;92:1251-3. doi: 10.1097/00000539-200105000-00031.

Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perio-perative and periprocedural applications and limitations. Br J Anaesthesia. 2015; 115(2):171-82. doi: 10.1093/bja/aev226.

Phan H, Nahata MC. Clinical uses of dexmedetomidine in pediatric patients. Pediatr Drugs. 2008;10(1):49-69. doi: 10.2165/00148581-200810010-00006.

Morgan DEYu, Mihail MS. Klinicheskaya anesteziologiya: Per s angl. pod red. A.A. Bunyatyana. M.: Binom; 2005. (in Russian)

Kulikov AS, Lubnin AYu. Deksmedetomidin: novye vozmozhnosti v anesteziologii. Anesteziologiya i Reanimatologiya. 2013;1:37-41. (in Russian)

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

Bergese S, Candiotti K, Bokesch P, Zura A, Wisemandle W, Bekker A, AWAKE Study Group. A Phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fibrooptic intubation. Am J Ther. 2010;17(6):586-95. doi: 10.1097/MJT.0b013e3181d69072.

Mason KP, Lerman J. Review article: Dexmedetomidine in children: Current knowledge and future applications. Anesth Analg. 2011;113(5):1129-42. doi: 10.1213/ANE.0b013e31822b8629.

Arain SR, Ruehlow RM, Uhrich TD, Ebert T. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anest Analg. 2004:98(1):153-8. doi: 10.1213/01.ane.0000093225.39866.75.

Hayden JC, Breatnach C, Doherty DR et al. Efficacy of α2-agonists for sedation in pediatric critical care: a systematic review. Pediatr Crit Care Med. 2016 Feb;17(2):e66-75. doi: 10.1097/PCC.0000000000000599.

Mondarini MC, Sperotto F, Daverio M et al. Rando-mized Protocol for an adaptive multicenter, randomized, double-blind, placebo-controlled non profit clinical trials. Efficacy and safety of Dexmedetomidine for prevention of withdrawal syndrome in Pediatric ICU. Trial registration: AIFA ID TIP-15-01. 2018.

Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007 Mar;8(2):115-31. doi: 10.1097/01.PCC.0000257100.31779.41.

Díaz S, Rodarte A, Foley J, Capparelli E. Pharmacokinetics of dexmedetomidine in postsurgical pediatric intensive care unit patients: preliminary study. Pediatr Crit Care Med. 2007 Sep;8(5):419-24. doi: 10.1097/01.PCC.0000282046.66773.39.

Sottas CE, Anderson BJ. Dexmedetomidine: The new all-in-one drug in paediatric anaesthesia? Curr Opin Anaesthesiol. 2017;30:441-51. DOI:10.1097/ACO.0000000000000488

Bala E, Sessler DI, Nair DR et al. Motor and somatosensory evoked potentials are well maintained in patient given dexmedetomidine during spine surgery. Anesthesiology. 2008;109(3):417-25. doi: 10.1097/ALN.0b013e318182a467.

Deksdor. Orionfarma. M.;2013. P. 8.

Bohringer С, Hong Li. Is it time for an expanded role of dexmedetomidine in contemporary anesthesia practice? A clinician’s perspective. Transl Perioper Pain Med. 2018;5(3):55-62. ISSN: 2330-4871. PMCID: PMC6782065 NIHMSID: NIHMS1007610 PMID: 31595218.

Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res. 2011 Jul-Dec;5(2):128-33. doi: 10.4103/0259-1162.94750.

Published
2020-12-31
How to Cite
Havrylova, L. (2020). Experience with the dexmedetomidine for sedation in pediatric neurosurgery in the early postoperative period . Endovascular Neuroradiology, 33(3), 56-65. https://doi.org/10.26683/2304-9359-2020-3(33)-56-65