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DGDispatch
Dexmedetomidine Effective for Procedural Sedation in Children With Pervasive Developmental Delay and Other Neurobehavior Disorders: Presented at AAP
By Bruce Sylvester
ATLANTA, GA -- October 11, 2006 -- Successful and uneventful sedation using dexmedetomidine (Precedex) is possible for children with pervasive developmental delay (PDD) and other neurobehavior disorders, researchers reported here at the American Academy of Pediatrics (AAP) National Conference & Exhibition.
"Kids with autism or other neurobehavior disorders are often very difficult to evaluate because of their behavior," said lead investigator John Berkenbosch, MD, associate professor of pediatrics and pediatric critical care, University of Louisville School of Medicine, Louisville, Kentucky.
"Some of the older drugs that we have had used for sedation in order to perform evaluative procedures are associated with adverse behavioral problems during the recovery phase," Dr. Berkenbosch said during his presentation on October 9th.
Dexmedetomidine is a relatively new drug, and it is not used often for procedural sedation, he noted. Based on his own experience and that of some of his colleagues, Dr. Berkenbosch and his research team therefore decided to study the drug in a retrospective study using relevant data from their own hospitals.
The researchers identified patients with neurobehavior disorders who had been treated with dexmedetomidine for procedural sedation from databases at Chris Evert Children's Hospital in Fort Lauderdale, Florida (n = 176), and Kosair Children's Hospital in Louisville, Kentucky (n = 57). They collected and analyzed demographic and sedation-related data, including drug dosing, adjunct medication use, time to sedation, efficacy and complications.
They reported that 233 patients with a mean age of 5.9 years received dexmedetomidine for radiologic (n = 222) and/or neurophysiologic (n = 22) testing. Of these, 196 (84.1%) had PDD.
Intravenous (IV) dexmedetomidine was used to induce sedation with 1.2 mcg/kg over 7.9 minutes. Total dexmedetomidine dosing was 2.2 mcg/kg. There was 1 sedation failure (0.4%).
Patients had been premedicated with IV midazolam (0.09 mg/kg; n = 186), oral midazolam (0.5 mg/kg; n = 48) and/or oral dexmedetomidine (2.8 mg/kg; n = 8), to facilitate placement of the IV or to treat pre-sedation anxiety/agitation.
The investigators found a mean recovery time of 50 minutes.
Heart rate and blood pressure decreased modestly, but remained in the normal range for age. There were no episodes of desaturation.
The researchers reported that recovery for the children was "uneventful without agitation," and this included many patients who had had documented agitation while being treated with other drugs.
Parents' reports showed a high level of satisfaction, and there were no reported significant complications.
"Dexmedetomidine is an attractive sedative option for this population when noninvasive evaluations are required," the authors concluded. "We found that this agent could be used successfully for the uneventful sedation of kids with autism and other neurobehavioral disorders."
Dexmedetomidine is currently FDA-approved for sedation of initially-intubated and mechanically-ventilated adult patients during treatment in an intensive setting, and for up to 24 hours.
[Presentation title: Dexmedetomidine for Procedural Sedation in Children With Pervasive Developmental Delay and Neurobehavior Disorders. Abstract 1]
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