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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.
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