Table of Contents Author Guidelines Submit a Manuscript
International Journal of Pediatrics
Volume 2010, Article ID 825079, 6 pages
http://dx.doi.org/10.1155/2010/825079
Case Report

Extended Infusion of Dexmedetomidine to an Infant at Sixty Times the Intended Rate

1Department of Anesthesia, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 , USA
2Department of Anesthesia, Perioperative, and Pain Medicine, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA

Received 30 June 2010; Accepted 6 August 2010

Academic Editor: Savithiri Ratnapalan

Copyright © 2010 Bryan A. Max and Keira P. Mason. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. Y.-W. Hsu, L. I. Cortinez, K. M. Robertson et al., “Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers,” Anesthesiology, vol. 101, no. 5, pp. 1066–1076, 2004. View at Publisher · View at Google Scholar · View at Scopus
  2. K. P. Mason, D. Zurakowski, S. E. Zgleszewski et al., “High dose dexmedetomidine as the sole sedative for pediatric MRI,” Paediatric Anaesthesia, vol. 18, no. 5, pp. 403–411, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  3. P. Talke, C. A. Richardson, M. Scheinin, and D. M. Fisher, “Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine,” Anesthesia and Analgesia, vol. 85, no. 5, pp. 1136–1142, 1997. View at Publisher · View at Google Scholar · View at Scopus
  4. B. C. Bloor, D. S. Ward, J. P. Belleville, and M. Maze, “Effects of intravenous dexmedetomidine in humans: II. Hemodynamic changes,” Anesthesiology, vol. 77, no. 6, pp. 1134–1142, 1992. View at Google Scholar · View at Scopus
  5. S. Shah, T. Sangari, M. Qasim, and T. Martin, “Severe hypertension and bradycardia after dexmedetomidine for radiology sedation in a patient with acute transverse myelitis,” Paediatric Anaesthesia, vol. 18, no. 7, pp. 681–682, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  6. K. P. Mason, S. E. Zgleszewski, R. Prescilla, P. J. Fontaine, and D. Zurakowski, “Hemodynamic effects of dexmedetomidine sedation for CT imaging studies,” Paediatric Anaesthesia, vol. 18, no. 5, pp. 393–402, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  7. K. P. Mason, D. Zurakowski, S. Zgleszewski, R. Prescilla, P. J. Fontaine, and J. A. Dinardo, “Incidence and predictors of hypertension during high-dose dexmedetomidine sedation for pediatric MRI,” Paediatric Anaesthesia, vol. 20, no. 6, pp. 516–523, 2010. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  8. K. P. Mason, S. E. Zgleszewski, J. L. Dearden et al., “Dexmedetomidine for pediatric sedation for computed tomography imaging studies,” Anesthesia and Analgesia, vol. 103, no. 1, pp. 57–62, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  9. D. A. Rosen and J. T. Daume, “Short duration large dose dexmedetomidine in a pediatric patient during procedural sedation,” Anesthesia and Analgesia, vol. 103, no. 1, pp. 68–69, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  10. J. A. Aldrete and D. Kroulik, “A postanesthetic recovery score,” Anesthesia and Analgesia, vol. 49, no. 6, pp. 924–934, 1970. View at Google Scholar · View at Scopus
  11. Precedex (Dexmedetomidine) Package Insert, Hospira, Lake Forest, Ill, USA, 2008.
  12. R. Virtanen, J.-M. Savola, V. Saano, and L. Nyman, “Characterization of the selectivity, specificity and potency of medetomidine as an α2-adrenoceptor agonist,” European Journal of Pharmacology, vol. 150, no. 1-2, pp. 9–14, 1988. View at Google Scholar · View at Scopus
  13. J. P. Belleville, D. S. Ward, B. C. Bloor, and M. Maze, “Effects of intravenous dexmedetomidine in humans: I. Sedation, ventilation, and metabolic rate,” Anesthesiology, vol. 77, no. 6, pp. 1125–1133, 1992. View at Google Scholar · View at Scopus
  14. S. Z. Langer, “Presynaptic regulation of the release of catecholamines,” Pharmacological Reviews, vol. 32, no. 4, pp. 337–362, 1980. View at Google Scholar · View at Scopus
  15. G. M. Drew and S. B. Whiting, “Evidence for two distinct types of postsynaptic α-adrenoceptor in vascular smooth muscle in vivo,” British Journal of Pharmacology, vol. 67, no. 2, pp. 207–215, 1979. View at Google Scholar · View at Scopus
  16. M. Laubie, H. Schmitt, and M. Vincent, “Vagal bradycardia produced by microinjections of morphine-like drugs into the nucleus ambiguus in anaesthetized dogs,” European Journal of Pharmacology, vol. 59, no. 3-4, pp. 287–291, 1979. View at Google Scholar · View at Scopus
  17. M. Muzi, D. R. Goff, J. P. Kampine, D. L. Roerig, and T. J. Ebert, “Clonidine reduces sympathetic activity but maintains baroreflex responses in normotensive humans,” Anesthesiology, vol. 77, no. 5, pp. 864–871, 1992. View at Publisher · View at Google Scholar · View at Scopus
  18. J. R. Unnerstall, T. A. Kopajtic, and M. J. Kuhar, “Distribution of alpha 2 agonist binding sites in the rat and human central nervous system: analysis of some functional, anatomic correlates of the pharmacologic effects of clonidine and related adrenergic agents,” Brain Research, vol. 319, no. 1, pp. 69–101, 1984. View at Google Scholar · View at Scopus
  19. T. Ray and J. D. Tobias, “Dexmedetomidine for sedation during electroencephalographic analysis in children with autism, pervasive developmental disorders, and seizure disorders,” Journal of Clinical Anesthesia, vol. 20, no. 5, pp. 364–368, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  20. G. B. Hammer, D. R. Drover, H. Cao et al., “The effects of dexmedetomidine on cardiac electrophysiology in children,” Anesthesia and Analgesia, vol. 106, no. 1, pp. 79–83, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  21. M. W. König, M. A. Mahmoud, H. Fujiwara, N. Hemasilpin, K. H. Lee, and D. F. Rose, “Influence of anesthetic management on quality of magnetoencephalography scan data in pediatric patients,” Paediatric Anaesthesia, vol. 19, no. 5, pp. 507–512, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  22. Y. Üstün, M. Gündüz, Ö. Erdoǧan, and M. E. Benlidayi, “Dexmedetomidine versus midazolam in outpatient third molar surgery,” Journal of Oral and Maxillofacial Surgery, vol. 64, no. 9, pp. 1353–1358, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  23. S. Ogawa, H. Seino, H. Ito, S. Yamazaki, S. Ganzberg, and H. Kawaai, “Intravenous sedation with low-dose dexmedetomidine: its potential for use in dentistry,” Anesthesia Progress, vol. 55, no. 3, pp. 82–88, 2008. View at Google Scholar · View at Scopus
  24. K. P. Barton, R. Munoz, V. O. Morell, and C. Chrysostomou, “Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease,” Pediatric Critical Care Medicine, vol. 9, no. 6, pp. 612–615, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  25. C. Heard, F. Burrows, K. Johnson, P. Joshi, J. Houck, and J. Lerman, “A comparison of dexmedetomidine-midazolam with propofol for maintenance of anesthesia in children undergoing magnetic resonance imaging,” Anesthesia and Analgesia, vol. 107, no. 6, pp. 1832–1839, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  26. C. L. Carroll, D. Krieger, M. Campbell, D. G. Fisher, L. L. Comeau, and A. R. Zucker, “Use of dexmedetomidine for sedation of children hospitalized in the intensive care unit,” Journal of Hospital Medicine, vol. 3, no. 2, pp. 142–147, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  27. R. O. Lami and A. C. P. Pereira, “Transmucosal dexmedetomidine for computed tomography sedation,” Paediatric Anaesthesia, vol. 18, no. 4, pp. 349–378, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  28. G. B. Hammer, W. J. Sam, M. I. Chen, B. Golianu, and D. R. Drover, “Determination of the pharmacodynamic interaction of propofol and dexmedetomidine during esophagogastroduodenoscopy in children,” Paediatric Anaesthesia, vol. 19, no. 2, pp. 138–144, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  29. S. Vilo, P. Rautiainen, K. Kaisti et al., “Pharmacokinetics of intravenous dexmedetomidine in children under 11 yr of age,” British Journal of Anaesthesia, vol. 100, no. 5, pp. 697–700, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  30. J. E. Hall, T. D. Uhrich, J. A. Barney, S. R. Arain, and T. J. Ebert, “Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions,” Anesthesia and Analgesia, vol. 90, no. 3, pp. 699–705, 2000. View at Google Scholar · View at Scopus
  31. P. Talke, E. Lobo, and R. Brown, “Systemically administered α2-agonist-induced peripheral vasoconstriction in humans,” Anesthesiology, vol. 99, no. 1, pp. 65–70, 2003. View at Publisher · View at Google Scholar · View at Scopus
  32. K. P. Mason, E. O'Mahony, D. Zurakowski, and M. H. Libenson, “Effects of dexmedetomidine sedation on the EEG in children,” Paediatric Anaesthesia, vol. 19, no. 12, pp. 1175–1183, 2009. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  33. E. Ingersoll-Weng, G. R. Manecke Jr., and P. A. Thistlethwaite, “Dexmedetomidine and Cardiac Arrest,” Anesthesiology, vol. 100, no. 3, pp. 738–739, 2004. View at Publisher · View at Google Scholar · View at Scopus
  34. H. Xu, M. Aibiki, K. Seki, S. Ogura, and K. Ogli, “Effects of dexmedetomidine, an α2-adrenoceptor agonist, on renal sympathetic nerve activity, blood pressure, heart rate and central venous pressure in urethane-anesthetized rabbits,” Journal of the Autonomic Nervous System, vol. 71, no. 1, pp. 48–54, 1998. View at Publisher · View at Google Scholar · View at Scopus
  35. G. Erkonen, F. Lamb, and J. D. Tobias, “High-dose dexmedetomidine-induced hypertension in a child with traumatic brain injury,” Neurocritical Care, vol. 9, no. 3, pp. 366–369, 2008. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  36. J. W. Berkenbosch and J. D. Tobias, “Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin,” Pediatric Critical Care Medicine, vol. 4, no. 2, pp. 203–205, 2003. View at Google Scholar · View at Scopus
  37. M. A. Ramsay, T. M. Savege, B. R. Simpson, and R. Goodwin, “Controlled sedation with alphaxalone-alphadolone,” British Medical Journal, vol. 2, no. 920, pp. 656–659, 1974. View at Google Scholar · View at Scopus
  38. K. P. Mason, E. Michna, D. Zurakowski et al., “Value of bispectral index monitor in differentiating between moderate and deep Ramsay sedation scores in children,” Paediatric Anaesthesia, vol. 16, no. 12, pp. 1226–1231, 2006. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  39. V. S. B. Jorden, R. M. Pousman, M. M. Sanford, P. A. J. Thorborg, and M. P. Hutchens, “Dexmedetomidine overdose in the perioperative setting,” Annals of Pharmacotherapy, vol. 38, no. 5, pp. 803–807, 2004. View at Publisher · View at Google Scholar · View at PubMed · View at Scopus
  40. T. J. Ebert, J. E. Hall, J. A. Barney, T. D. Uhrich, and M. D. Colinco, “The effects of increasing plasma concentrations of dexmedetomidine in humans,” Anesthesiology, vol. 93, no. 2, pp. 382–394, 2000. View at Google Scholar · View at Scopus