Dexmedetomidine for continuous IV infusion in Cardiac Theatres, Paediatric

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.