Farmacoriflessioni
Dexmedetomidina
Dexmedetomidine: why should paediatricians know it?
Marialaura Marrazzo1, Anna Galletti1, Sara Solidoro1, Andrea Ballaben1, Egidio Barbi2
1Università di Trieste
2IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Novembre 2024 - pagg. 569 -574 | DOI: 10.53126/MEB43569
Abstract
Procedural sedation is often required in paediatrics to execute diagnostic procedures. There are many sedative drugs that may be used, but all of them carry not negligible side effect risks and may not be easy to manage. The use of dexmedetomidine has increased in the last few years because of its sedation efficacy in painless procedures. Paediatricians should know the use of dexmedetomidine because of its sensational safety profile even in neonates, its administration route versatility, its neuroprotective properties and its in-home palliative care role in children with otherwise untreatable sleep disorders. This article summarizes the main characteristics of dexmedetomidine, its use, strengths and weaknesses.
Riassunto
La sedazione procedurale è molto spesso richiesta in Pediatria per poter effettuare indagini diagnostiche, soprattutto radiologiche. I farmaci sedativi sono numerosi e non scevri da effetti collaterali e complessità di utilizzo. Negli ultimi anni l’utilizzo della dexmedetomidina si è diffuso sempre di più, in ragione della grande efficacia sedativa in procedure non dolorose. Il profilo di sicurezza della dexmedetomidina, anche in ambito neonatale, la sua azione neuroprottettiva, la versatilità delle vie di somministrazione (in particolare endonasale) e, infine, la possibilità di uso a domicilio in ambito di cure palliative in bambini con disturbo del sonno altrimenti intrattabile, la rendono un farmaco prezioso che dovrebbe far parte del bagaglio culturale del pediatra. Il seguente articolo espone le principali caratteristiche, modi di utilizzo, pregi e difetti del farmaco.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Weerink MAS, Struys MMRF, Hannivoort LN, Barends CRM, Absalom AR, Colin P. Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine. Clin Pharmacokinet. 2017. doi: 10.1007/s40262-017-0507-7.
2. Mahmoud M, Barbi E. Dexmedetomidine : What ‘ s New for Pediatrics? A Narrative Review. J Clin Med 2020;9(9):2724. doi: 10.3390/jcm9092724.
3. Degos V, Le Charpentier T, Chhor V, et al. Neuroprotective Effects of Dexmedetomidine against Glutamate Agonist-induced Neuronal Cell Death Are Related to Increased Astrocyte Brain-derived Neurotrophic Factor Expression. Anesthesiology 2013;118(5):1123-32. doi: 10.1097/ALN.0b013e318286cf36.
4. Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth 2015:115(2):171-82. doi: 10.1093/bja/aev226.
5. Freriksen JJM, Zanden TM Van Der, Holsappel IGA, Molenbuur B. 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. Pediatr Drugs 2022;24(3):247-57. doi: 10.1007/s40272-022-00498-y.
6. Gong M, Man Y, Fu Q. Incidence of bradycardia in pediatric patients receiving dexmedetomidine anesthesia: a meta-analysis. Int J Clin Pharm 2017;39(1):139-47. doi: 10.1007/ s11096-016-0411-5.
7. Lin Y, Zhang R, Shen W, et al. Dexmedetomidine versus other sedatives for non-painful pediatric examinations : A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2020;62:109736. doi: 10.1016/j.jclinane.2020.109736.
8. Ahmed SS, Unland T, Slaven JE, Nitu ME. High Dose Dexmedetomidine : Effective as a Sole Agent Sedation for Children Undergoing MRI. Int J Pediatr 2015;2015:397372. doi: 10.1155/2015/397372.
9. Sulton C, McCracken C, Simon HK, et al. Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium. Hosp Pediatr 2016; 6(9):536-44. doi: 10.1542/hpeds.2015-0280.
10. Najafi N, Veyckemans F, Velde A Van De, Poelaert J. Usability of dexmedetomidine for deep sedation in infants and small children with respiratory morbidities. Acta Anaesthesiol Scand 2016:60(7):865-73. doi: 10.1111/ aas.12715.
11. Mason KP, Zgleszewski SE, Dearden JL, et al. Dexmedetomidine for Pediatric Sedation for Computed Tomography Imaging Studies. Anesth Analg 2006;103(1):57-62, table of contents. doi: 10.1213/01.ane. 0000216293. 16613.15.
12. Mondardini MC, Amigoni A, Cortellazzi P, et al. Intranasal dexmedetomidine in pediatrics : update of current knowledge. Minerva Anestesiol 2019;85(12):1334-45. doi: 10.23736/S0375-9393.19.13820-5.
13. Marra P, Stadio A Di, Colacurcio V, et al. Sedation with Intranasal Dexmedetomidine in the Pediatric Population for Auditory Brainstem Response Testing : Review of the Existing Literature. Healthcare 2022;10(2): 287. doi: 10.3390/healthcare10020287.
14. Plambech MZ, Afshari A. Dexmedetomidine in the pediatric population: a review. Minerva Anestesiol 2015;81(3):320-32.
15. Chen H, Yang F, Ye M, et al. Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children. BMC Anesthesiol 2020;20(1):61. doi: 10.1186/s12871-020-00978-z.
16. De Zen L, Divisic A, Molinaro G, Solidoro S, Barbi E. Dexmedetomidine at Home for Intractable Dystonia and Insomnia in Children With Special Needs: A Case Series. J Pain Symptom Manage 2023;66(6):e653-e657. doi: 10.1016/j.jpainsymman.2023.07. 018.
17. Zhou X, Zhao J, Tu H, Chen K, Hu Y, Jin Y. The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam American Society of Anesthesiology. Eur J Pediatr 2024;183(1):169-77. doi: 10.1007/s00431-023-05240-5.
18. Mason KP, Lubisch N, Robinson F, Roskos R, Epstein MA. Intramuscular Dexmedetomidine: An Effective Route of Sedation Preserves Background Activity for Pediatric Electroencephalograms. J Pediatr 2012;161 (5):927-32.e2. doi: 10.1016/j.jpeds.2012.05. 011.
19. Sahyoun C, Krauss B, Bevacqua M, Antonsen A, Jardinier L, Barbi E. Safety and Efficacy Associated With a Family-Centered Procedural Sedation Protocol for Children With Autism Spectrum Disorder or Developmental Delay. JAMA Netw Open 2023;6(5): 24-7. doi: 10.1001/jamanetworkopen.2023. 15974.
20. Venkatraman R, Hungerford JL, Hall MW, Moore-clingenpeel M, Tobias JD. Dexmedetomidine for Sedation During Noninvasive Ventilation in Pediatric Patients. Pediatr CritCare Med 2017:8(9):831-7. doi: 10.1097/ PCC.0000000000001226.
21. Mondardini MC, Sperotto F, Daverio M, et al. Efficacy and safety of dexmedetomidine for prevention of withdrawal syndrome in the pediatric intensive care unit: protocol for an adaptive, multicenter, randomized, clinical trial. Trials 2019:20(1):710. doi: 10.1186/ s13063-019-3793-6.
22. O’Mara K, Gal P, Wimmer J, et al. Dexmedetomidine Versus Standard Therapy with Fentanyl for. J Pediatr Pharmacol Ther 2012;17(3):252-62. doi: 10.5863/1551-6776-17.3.252.
23. Chrysostomou C, Schulman SR, Castellanos MH, et al. A Phase II/III, Multicenter, Safety, Efficacy, and Pharmacokinetic Study of Dexmedetomidine in Preterm and Term Neonates. J Pediatr. 2014;164(2):276-282.e3. doi: 10.1016/j.jpeds.2013.10.002.
24. Bua J, Massaro M, Cossovel F, et al. Intranasal dexmedetomidine, as midazolam-sparing drug, for MRI in preterm neonates Analgesic efficacy of dipyrone in children: Still an absence of evidence. Pediatr Anesth 2014:28(8):747-8. doi: 10.1111/pan.13454.
25. Estkowski LM, Morris JL, Sinclair EA. Clinical Investigation Characterization of Dexmedetomidine Dosing and Safety. J Pediatr Pharmacol Ther 2015;20(2):112-8. doi: 10.5863/1551-6776-20.2.112.
26. De Zen L, Marchetti F, Barbi E, Benini F. Cure palliative pediatriche e uso di farmaci off-label. Medico e Bambino 2019;38(2):97-102.
27. De Zen L, Della Paolera S, Del Rizzo I, Taucar V, Skabar A, Barbi E. Home Intranasal Dexmedetomidine for Refractory Dystonia in Pediatric Palliative Care. J Pain Symptom Manage 2020;59(6):e3-e5. doi: 10. 1016/j.jpainsymman.2020.02.022.
Corrispondenza: andreaballaben@gmail.com