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. 2021;26(1):81-86.
doi: 10.5863/1551-6776-26.1.81. Epub 2021 Jan 4.

Prevention of Withdrawal in Pediatric Patients Receiving Long-term Dexmedetomidine Infusions

Zachary J Berrens, Ashley L Sauro, Emma M Tillman

Prevention of Withdrawal in Pediatric Patients Receiving Long-term Dexmedetomidine Infusions

Zachary J Berrens et al. J Pediatr Pharmacol Ther. 2021.

Abstract

Objective: Determine if the addition of clonidine was associated with a decreased incidence of dexmedetomidine withdrawal in patients who received prolonged dexmedetomidine infusions.

Methods: This was a retrospective observational cohort study conducted at a single-center PICU in an academic children's hospital. Children 1 month to 18 years of age who received dexmedetomidine infusion for 5 days or longer were included in the study.

Results: Fifty patients met the inclusion criteria with 15 patients who received clonidine and 35 who received a dexmedetomidine wean alone. Withdrawal criteria included blood pressure changes, heart rate changes, and documented agitation. Overall, there was no difference in change in blood pressure or documented agitation between groups. Patients who did not receive clonidine had a greater number of heart rate readings above normal for age following discontinuation of the infusion, yet this was not statistically significant. Potentially more importantly, the addition of clonidine did not impact the duration of dexmedetomidine wean or the PICU length of stay after dexmedetomidine discontinuation.

Conclusions: The addition of clonidine while weaning a long-term dexmedetomidine infusion did not lead to lower blood pressures or agitation, but did lead to decreased percentage of heart rates above the age-appropriate range. The clinical significance of this is unknown, and further investigation is warranted. The addition of clonidine did not decrease time to weaning off dexmedetomidine or shorten PICU length of stay.

Keywords: adrenergic alpha-2 receptor agonists; child; clonidine; critical care; dexmedetomidine; withdrawal.

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Conflict of interest statement

Disclosure. The authors declare no conflicts or financial interest in any product or service mentioned in the manuscript, including grants, equipment, medications, employment, gifts, and honoraria. The authors have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Figures

Figure 1.
Figure 1.
Percentage of elevated blood pressure before and after discontinuation of dexmedetomidine.
Figure 2.
Figure 2.
Percentage of heart rate before and after discontinuation of dexmedetomidine.
See this image and copyright information in PMC

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