Dexmedetomidine for continuous IV infusion in Cardiac Theatres, Paediatric

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DEXMEDETOMIDINE HYDROCHLORIDE

Actions

  • Specific Alpha 2-adrenoceptor agonist
  • Sedative, analgesic and anaesthetic properties

Indications

  • As part of a balanced anaesthetic technique for children enrolled in the fast track cardiac pathway.

Benefits

  • Earlier extubation due to opioid sparing effect and reduction of stress response.
  • Attenuation of haemodynamic and neuroendocrine response at time of incision, sternotomy and post bypass and surgery.
  • Post op sedation and anxiolysis with minimum effect on respiratory drive and maintenance of airway patency.
  • Reduction in emergence delirium
  • Reduction in post operative opiate requirements

Preparation

Presentation

  • Dexmedetomidine 100 micrograms/ml in 2ml ampules

Preparation

  • Add Dexmedetomidine 200micrograms(2mls) to 48 mls of 0.9% sodium chloride or 5%glucose.
  • Final concentration=4micrograms/ml

Administration

  • Can be administered centrally or peripherally
  • Must be administered as an IV infusion via an infusion pump.
  • Not to be given as a bolus due potent cardiac side effects.

Dosage

Loading dose

  • 1microgram/kg over 60 minutes (Can be given over 10 minutes but consider side effects)

Maintenance infusion

  • 0.5micrograms/kg/hour
  • Stop infusion prior to protamine administration or 30 minutes before extubation in a non bypass case.

Monitoring

Continuous blood pressure, heart rate and saturation monitoring

Adverse reactions

  • Bradycardia (average <15%)-due to direct depression at both AV and sinus nodes
  • Biphasic blood pressure response. Hypertension with loading dose followed by dose dependent hypotension.
  • Somnolence
  • Nausea, dry mouth
  • Respiratory depression

Contraindications

  • Known hypersensitivity to Dexmedetomidine
  • Advanced heart block (2 or 3) unless paced
  • Uncontrolled hypotension
  • Acute cerebrovascular conditions

 

Cautions

  • Bradycardia
  • Hypovolaemia
  • Ventricular dysfunction
  • Hepatic impairment

Compatibility

Ringers lactate, 5% glucose, sodium chloride 0.9%, mannitol 20%, thiopentalsodium, etomidate, vecuronium, pancuronium, rocuronium, atracurium, mivacurium, succinylcholine, glycopyrlate, atropine, phenylephrine, dopamine, adrenaline, noradrenaline, dobutamine, midazolam, morphine, fentanyl, atropine

Incompatibility

Those not listed above. Contact local pharmacist. Unknown compatibility with blood and plasma. 

References
  1. Tobias JD. Dexmedetomidine:Applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med.2007;8(2):115-131
  2. Tobias JD, Gupta P, Naguib A. Dexmedetomidine:Applications for the Pediatric Patient With Congenital Heart Disease. Pediatr Cardiol. 2011;32:1075-1087
  3. Mittnacht AJ, Hollinger I. Fast tracking in pediatric cardiac surgery: The current standing. Ann Card Anaesth.2010;13:92-101
  4. Naguib A, Tobias JD, Hall MW et al. The Role of Different Anaesthetic Techniques in Altering the Stress Response During Cardiac Surgery in Children: A Prospective, Double Blinded, and Randomised Study. Pediatr Crit Care Med. 2013;14(5)
  5. Yuan VMY. Dexmedetomidine: perioperative applications in children. Pediatric Anaesthesia.2010;20:256-264
  6. Totonchi Z, Rezvani H, Ghorbanloo M et al. Effect of dexmedetomidine infusion on haemodynamics and stress responses in pediatric cardiac surgery: A randomised trial. Res Cardiovasc Med. 2017;6(1)
  7. Chrysostomou C, Di Filippo S, Manrique AM, et al. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med 2006; 7:126 –131
  8. Gamal Z. El-Morsy , Adel F. Elgamal. Dexmedetomidine; anadjuvant drug for fast track technique in pediatric cardiac surgery. Egyptian Journal of Anaesthesia (2014) 30, 347–351
  9. Risaac. Dexmedetomidine for continuous IV infusion. Birmingham Children’s Hospital  Injectable Medicine Guide.Version 1, Dec 2017 
  10. https://www.scribd.com/doc/59347779/IV-Compatibility-Chart
Editorial Information

Last reviewed: 03 June 2020

Next review: 03 June 2021

Author(s): Adele King

Version: 1

Co-Author(s): S. Bowhay

Approved By: Children's Hospital Drugs and Therapeutics Committee