Cargando…

Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary

BACKGROUND: Dexmedetomidine is currently off-label for use in pediatric clinical care worldwide. Nevertheless, it is frequently prescribed to pediatric patients as premedication prior to induction of anesthesia or for procedural sedation. There is ample literature on the pharmacokinetics, efficacy a...

Descripción completa

Detalles Bibliográficos
Autores principales: Freriksen, Jolien J. M., van der Zanden, Tjitske M., Holsappel, Inge G. A., Molenbuur, Bouwe, de Wildt, Saskia N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068679/
https://www.ncbi.nlm.nih.gov/pubmed/35344192
http://dx.doi.org/10.1007/s40272-022-00498-y
_version_ 1784700269306576896
author Freriksen, Jolien J. M.
van der Zanden, Tjitske M.
Holsappel, Inge G. A.
Molenbuur, Bouwe
de Wildt, Saskia N.
author_facet Freriksen, Jolien J. M.
van der Zanden, Tjitske M.
Holsappel, Inge G. A.
Molenbuur, Bouwe
de Wildt, Saskia N.
author_sort Freriksen, Jolien J. M.
collection PubMed
description BACKGROUND: Dexmedetomidine is currently off-label for use in pediatric clinical care worldwide. Nevertheless, it is frequently prescribed to pediatric patients as premedication prior to induction of anesthesia or for procedural sedation. There is ample literature on the pharmacokinetics, efficacy and safety of dexmedetomidine in this vulnerable patient population, but there is a general lack of consensus on dosing. In this project, we aimed to use the standardized workflow of the Dutch Pediatric Formulary to establish best evidence-based pediatric dosing guidelines for dexmedetomidine as premedication and for procedural sedation. METHOD: The available literature on dexmedetomidine in pediatrics was reviewed in order to address the following three questions: (1) What is the right dose? (2) What is known about efficacy? (3) What is known about safety? Relevant literature was compiled into a risk–benefit analysis document. A team of clinical experts critically appraised the analysis and the proposed dosing recommendations. RESULTS: Dexmedetomidine is most commonly administered via the intravenous or intranasal route. Clearance is age dependent, warranting higher doses in infants to reach similar exposure as in adults. Dexmedetomidine use results in satisfactory sedation at parent separation, adequate sedation and a favorable recovery profile. The safety profile is good and comparable to adults, with dose-related hemodynamic effects. CONCLUSION: Following the structured approach of the Dutch Pediatric Formulary, best evidence-based dosing recommendations were proposed for dexmedetomidine, used as premedication prior to induction of anesthesia (intranasal dose) and for procedural sedation (intranasal and intravenous dose) in pediatric patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40272-022-00498-y.
format Online
Article
Text
id pubmed-9068679
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-90686792022-05-07 Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary Freriksen, Jolien J. M. van der Zanden, Tjitske M. Holsappel, Inge G. A. Molenbuur, Bouwe de Wildt, Saskia N. Paediatr Drugs Original Research Article BACKGROUND: Dexmedetomidine is currently off-label for use in pediatric clinical care worldwide. Nevertheless, it is frequently prescribed to pediatric patients as premedication prior to induction of anesthesia or for procedural sedation. There is ample literature on the pharmacokinetics, efficacy and safety of dexmedetomidine in this vulnerable patient population, but there is a general lack of consensus on dosing. In this project, we aimed to use the standardized workflow of the Dutch Pediatric Formulary to establish best evidence-based pediatric dosing guidelines for dexmedetomidine as premedication and for procedural sedation. METHOD: The available literature on dexmedetomidine in pediatrics was reviewed in order to address the following three questions: (1) What is the right dose? (2) What is known about efficacy? (3) What is known about safety? Relevant literature was compiled into a risk–benefit analysis document. A team of clinical experts critically appraised the analysis and the proposed dosing recommendations. RESULTS: Dexmedetomidine is most commonly administered via the intravenous or intranasal route. Clearance is age dependent, warranting higher doses in infants to reach similar exposure as in adults. Dexmedetomidine use results in satisfactory sedation at parent separation, adequate sedation and a favorable recovery profile. The safety profile is good and comparable to adults, with dose-related hemodynamic effects. CONCLUSION: Following the structured approach of the Dutch Pediatric Formulary, best evidence-based dosing recommendations were proposed for dexmedetomidine, used as premedication prior to induction of anesthesia (intranasal dose) and for procedural sedation (intranasal and intravenous dose) in pediatric patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40272-022-00498-y. Springer International Publishing 2022-03-28 2022 /pmc/articles/PMC9068679/ /pubmed/35344192 http://dx.doi.org/10.1007/s40272-022-00498-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc/4.0/Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research Article
Freriksen, Jolien J. M.
van der Zanden, Tjitske M.
Holsappel, Inge G. A.
Molenbuur, Bouwe
de Wildt, Saskia N.
Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary
title Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary
title_full Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary
title_fullStr Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary
title_full_unstemmed Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary
title_short Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary
title_sort best evidence-based dosing recommendations for dexmedetomidine for premedication and procedural sedation in pediatrics: outcome of a risk-benefit analysis by the dutch pediatric formulary
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9068679/
https://www.ncbi.nlm.nih.gov/pubmed/35344192
http://dx.doi.org/10.1007/s40272-022-00498-y
work_keys_str_mv AT freriksenjolienjm bestevidencebaseddosingrecommendationsfordexmedetomidineforpremedicationandproceduralsedationinpediatricsoutcomeofariskbenefitanalysisbythedutchpediatricformulary
AT vanderzandentjitskem bestevidencebaseddosingrecommendationsfordexmedetomidineforpremedicationandproceduralsedationinpediatricsoutcomeofariskbenefitanalysisbythedutchpediatricformulary
AT holsappelingega bestevidencebaseddosingrecommendationsfordexmedetomidineforpremedicationandproceduralsedationinpediatricsoutcomeofariskbenefitanalysisbythedutchpediatricformulary
AT molenbuurbouwe bestevidencebaseddosingrecommendationsfordexmedetomidineforpremedicationandproceduralsedationinpediatricsoutcomeofariskbenefitanalysisbythedutchpediatricformulary
AT dewildtsaskian bestevidencebaseddosingrecommendationsfordexmedetomidineforpremedicationandproceduralsedationinpediatricsoutcomeofariskbenefitanalysisbythedutchpediatricformulary