Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep;30(9):1013-1019.
doi: 10.1111/pan.13945. Epub 2020 Jul 26.

Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study

Proshad N Efune  1   2 , John M Longanecker  3 , Gijo Alex  1 , Rita Saynhalath  1   2 , Umar Khan  4 , Kevin Rivera  1 , Aveline P Jerome  1 , Weiwei Boone  4 , Peter Szmuk  1   2
Affiliations

Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study

Proshad N Efune et al. Paediatr Anaesth. 2020 Sep.

Abstract

Background: Anesthetic regimens using dexmedetomidine and short-acting opioids have been suggested as potential alternatives to sevoflurane-based anesthesia in children. The primary aim of this study is to compare demographics, intraoperative characteristics, and complications of general anesthetics in which dexmedetomidine and opioids were used without sevoflurane, or in combination with a low sevoflurane concentration, in children 36 months old and younger. The secondary aim is to evaluate intraoperative bispectral index (BIS) values when available in these patients.

Methods: General anesthetics performed between January 1, 2017, and May 1, 2018, in children 2 years and younger who received dexmedetomidine and remifentanil, with or without sevoflurane, were identified. Additional anesthetics performed during this time in children 36 months and younger who received dexmedetomidine and opioids and had BIS monitoring were also identified. Charts were reviewed for demographic and intraoperative variables, including drug administration and hemodynamic data.

Results: A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety-two patients received sevoflurane with a mean end-tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1-0.3, P < .001) and more dexmedetomidine (median dose 0.9 μg/kg/h vs 0.3 μg/kg/h, difference of 0.6 μg/kg/h, 95% CI 0.4-0.8, P < .001), and had a higher mean arterial pressure (median 53 mm Hg vs 42 mm Hg, difference of 11 mm Hg, 95% CI 8.1-14.8, P < .001). Complications between the two groups were comparable. The median percent intraoperative time with BIS reading <60 was 71.6% (95% CI: 63.3%-79.8%).

Conclusion: Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without <1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.

Keywords: TIVA; child < age; general anesthesia; infant < age; intravenous agents < drugs; neurodevelopment.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Andropoulos DB, Greene MF. Anesthesia and developing brains - implications of the FDA warning. N Engl J Med. 2017;376(10):905-907.
    1. Szmuk P, Andropoulos D, McGowan F, et al. An open label pilot study of a dexmedetomidine-remifentanil-caudal anesthetic for infant lower abdominal/lower extremity surgery: the TREX pilot study. Pediatr Anesth. 2019;29(1):59-67.
    1. Van Hoorn CE, Skowno J, Laklwani K, et al. Dexmedetomidine in Paediatric Care: A Survey Among Paediatric Anaesthesiologists in Europe, Australia, New Zealand and the USA. Rotterdam: European Society for Paediatric Anaesthesiology; 2019.
    1. Dwass M. Some k-sample rank-order tests. In: Gleser LJ, Perlman MD, Press SJ, Sampson AR, eds. Contributions to Probability and Statistic. Stanford, CA: Stanford University Press; 1960:198-202.
    1. De C, Ma F. On distribution-free multiple comparisons in the one-way analysis of variance. Commun Statist Theor Meth. 1991;20(1):127-139.

LinkOut - more resources