Anesth Analg 2006;103:250
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000228303.92422.73
LETTER TO THE EDITOR
Preliminary Experience with Dexmedetomidine in Pediatric Anesthesia
Ahmed M. Mukhtar, MD,
Eman M. Obayah, MD, and
Amira M. Hassona
Anesthesiology Department; Pediatric Cardiac Anesthesia Unit; ahmed3m2003{at}yahoo.com (Mukhtar)
Biochemistry Department; Cairo University, Egypt (Obayah, Hassona)
To the Editor:
We agree with the editorial comments of Tobin et al. (1), in the editorial in the current issue of Anesthesia & Analgesia. We conducted our study (2) hoping to pave the way for future investigations on dexmedetomidine in the pediatric population.
The concurrent publication of four manuscripts about dexmedetomidine in children suggests that pediatric anesthesiologists believe that dexmedetomidine has an important clinical role in pediatric anesthesiology. Although our results suggest potential beneficial effects, widespread use in children can only be recommended after thorough investigation.
As pointed out in the editorial, the current literature lacks dose-response guidelines for the use of dexmedetomidine in pediatrics. Tobias and Bergenbosch (3) described doses ranging from 0.2 to 0.75 µg/kg/h in various pediatric case reports, similar to adult doses ranging from 0.2–2.5 µg/kg/h (4). In our study, we used a dose of 0.5 µg/kg/h, similar to the previously described doses. Despite the relatively small sample size in our study, we were able to demonstrate beneficial hemodynamic and neuroendocrine effects of dexmedetomidine compared with placebo.
We used dexmedetomidine as an adjuvant to the anesthetic protocol that was standardized in both study arms, to evaluate its additional effects on current anesthetic management. Although there were no differences between anesthetic concentrations in both groups, we believe the specific hemodynamic effects of dexmedetomidine preclude using arterial blood pressure and heart rate to guide intraoperative titration. A more precise method of monitoring depth of anesthesia, perhaps by using processed electroencephalogram, is needed to guide intraoperative titration of dexmedetomidine.
Finally, we strongly agree that more study is needed to understand the safety and efficacy of dexmedetomidine in pediatric patients. Cooperation among research institutes, pharmaceutical companies, and funding agencies appears crucial to fill the frequently encountered gap in clinical trials investigating new drugs in pediatrics.
REFERENCES
- Tobin JR, Shafer SL, Davis PJ. Pediatric research and scholarship: another ’Gordian knot’? Anesth Analg 2006;103:43–8.[Free Full Text]
- Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg 2006;103: 52–6.[Abstract/Free Full Text]
- Tobias JD, Berenbosch JW. Initial experience with dexmedetomidine in pediatric-aged patients. Paediatr Anaesth 2002;12: 171–5.[Web of Science][Medline]
- Venn RM, Bryant A, Hall GM, Grounds RM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in postoperative patients needing sedation in the intensive care unit. Br J Anaesth 2001;86:650–6.[Abstract/Free Full Text]
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