alexa Prolonged Use of Dexmedetomidine Infusion in an Infant for Sedation as Adjuvant Therapy | OMICS International
ISSN: 2165-7386
Journal of Palliative Care & Medicine
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Prolonged Use of Dexmedetomidine Infusion in an Infant for Sedation as Adjuvant Therapy

Paola Genovese1*, Joseph Tobias1 and Anjana Kundu2

1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA

2Department of Anesthesiology, Dayton Children's Hospital, Ohio, USA

*Corresponding Author:
Paola Genovese
Department of Anesthesiology and Pain Medicine
Nationwide Children's Hospital, Columbus, Ohio, USA
Tel: (614) 722-4200
Fax: (614) 722-4203
E-mail: [email protected]

Received date: December 08, 2016; Accepted date: September 11, 2017; Published date: September 16, 2017

Citation: Genovese P, Tobias J, Kundu A (2017) Prolonged Use of Dexmedetomidine Infusion in an Infant for Sedation as Adjuvant Therapy. J Palliat Care Med 7:319. doi:10.4172/2165-7386.1000319

Copyright: © 2017 Genovese P, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Palliative Care & Medicine


Dexmedetomidine, a central and peripheral alpha-2 receptor agonist approved by the FDA for the use in patients 18 years old and older, it has been increasingly used in the pediatric population for sedation and analgesia due to its advantage of minimal respiratory depression and lack of abuse/dependence. This is a case report of a successful use of dexmedetomidine in an infant for 15 weeks achieving; symptom control, reduction in the dose of opioids and benzodiazepines by 50% and a safe transition to oral equivalents.


Dexmedetomidine; Pediatrics; Dexmedetomidine prolonged use; Opioid adjuvant


Dexmedetomidine is a central and peripheral alpha-2 receptor agonist; its analgesic therapeutic effects are mediated centrally. The alpha-2 receptor is located on the vascular pre-synaptic neuron terminals where it inhibits the release of norepinephrine via negative feedback [1].

The medication is approved by the FDA for 24 hours or less for sedation in patients 18 y/o and older [2] in intubated and nonintubated patients in the Intensive Care setting and/or during surgical procedures. Another quality is its analgesic properties, although it may not be sufficient to use it alone, it has been used more and more frequently as an adjunctive agent along opioids.

It has been increasingly used off-label in the pediatric population for sedation and analgesia due to its advantage in safety, minimal to none respiratory depression and lack of dependence/abuse potential compared to other more traditional options (opioids/benzodiazepines) [3-5].

We report the efficacy and safety of the use of Dexmedetomidine infusion for a prolonged duration in an infant beyond current manufacturer and FDA recommendations.

Case Presentation

The patient was a male infant born at 34 weeks of gestational age due to preterm labor with the following diagnosis at birth: Trisomy 21, Esophageal stenosis, Duodenal atresia, Annular pancreas, complete balanced Atrio-Ventricular septal defect. With the following major complications during the hospitalization; Mixed apneas, tracheostomy placement, mechanical ventilation dependence, secondary pulmonary hypertension, venous and arterial clotting episodes leading to Leftabove the knee amputation, multifocal brain infarcts and seizures (Figure 1).


Figure 1: 50% reduction of opioid and benzodiazepine doses overtime.

He required for sedation and analgesia the continuous infusion of; a benzodiazepine (Midazolam – maximum used dose 0.4 mg/kg/h) and an opioid together (Hydromorphone –maximum used dose: 0.7 mg/kg/h). After 11 weeks of unsuccessful pain control/unacceptable comfort level and inability to wean benzodiazepines and opioids dexmedetomidine was added to his regimen. The clinical goals were to decrease pain, improve comfort level and to wean opioids and benzodiazepines. The clinical parameters we followed were; Heart rate (HR), blood pressure (BP) and pain scale (FLACC score) as subrogate for sedation/comfort. The patient was ventilator-dependent therefore the effects of dexmedetomidine on the respiratory rate could not be evaluated (Figure 2).


Figure 2: FLACC score - Blood Pressure (BP) - Heart rate (HR) correlation with dose of medications on Figure 1.


In 5 weeks, while on Dexmedetomidine the doses of benzodiazepine and opioid were decreased by at least 50% achieving the same or better degree of pain control/comfort. The doses decreased from 0.2 to 0.1 mg/kg/h for midazolam and from 0.3 to 0.07 mg/kg/h for hydromorphone.

In the 15 weeks of infusion of Dexmedetomidine, the patient did not show side-effects that required medical intervention (Bradycardia, Hypotension) he had one event of bradycardia/hypotension due to sepsis, but not related to the medication proved by the fact he recover his baseline parameters when the infection was controlled without changes in the dose of dexmedetomidine.

The patient was successfully transitioned to another alpha-2 agonist; oral clonidine over a 5-day transition without rebound of hypertension, tachycardia or an increase of the dose of opioids or benzodiazepines.


Dexmedetomidine was safely used for longer than 24 hours (15 weeks, in this case) in a pediatric patient without major side-effects showing a potential expansion in the time and age limit of use of Dexmedetomidine. Another potential use of Dexmedetomidine is as an opioid and benzodiazepine adjuvant, allowing reduction to the dose of these medications, decreasing the potential side-effects and dependence on them, along with speeding up the weaning of these two potentially dangerous medications without creating dependence on its substitute. Besides the lack of dependence, the easy transition from an intravenous to an oral medication with similar properties (Clonidine, another alpha-2 agonist) makes the decision to introduce and use dexmedetomidine as an opioid/benzodiazepine adjuvant even more tempting in the ICU setting when aiming for faster transition off of continuous infusions and decreasing the hospital stay in ICU.


Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Recommended Conferences

Article Usage

  • Total views: 441
  • [From(publication date):
    September-2017 - Aug 15, 2018]
  • Breakdown by view type
  • HTML page views : 399
  • PDF downloads : 42

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2018-19
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri & Aquaculture Journals

Dr. Krish

[email protected]

+1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A


[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals


porn sex

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

Gaziantep Escort

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A


[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

mp3 indir

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals


Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T


[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001Extn: 9042

© 2008- 2018 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version