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Erschienen in: Neurocritical Care 3/2008

01.12.2008 | Practical Pearl

High-dose Dexmedetomidine-induced Hypertension in a Child with Traumatic Brain Injury

verfasst von: Gwen Erkonen, Fred Lamb, Joseph D. Tobias

Erschienen in: Neurocritical Care | Ausgabe 3/2008

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Abstract

Introduction

Dexmedetomidine is a centrally acting α2-adrenergic agonist which is currently FDA-approved for the short-term (less than 24 h) sedation of adults during mechanical ventilation.

Discussion

Given its beneficial physiologic properties, there has been increasing use of this agent in the pediatric population. As with any agent used for sedation in the Pediatric ICU setting, dose escalations may be necessary. Unlike benzodiazepines and opioids, there are limited data regarding the administration of dexmedetomidine above the current package insert dosing recommendations of 0.7 μg/kg/h.

Results

We report a 2-year-old child with traumatic brain injury who developed hypertension following the administration of a dexmedetomidine infusion at 4 μg/kg/h for several hours. Investigation into the etiology of the hypertension was negative and the blood pressure returned to baseline with a decrease in the infusion rate.

Conclusion

Subsequent to this, no further issues with hypertension were noted.
Literatur
1.
Zurück zum Zitat Virtanen R, Savola JM, Saano V, Nyman L. Characterization of selectivity, specificity, and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol. 1998;150:9–14.CrossRef Virtanen R, Savola JM, Saano V, Nyman L. Characterization of selectivity, specificity, and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol. 1998;150:9–14.CrossRef
2.
Zurück zum Zitat Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8:115–31.PubMedCrossRef Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8:115–31.PubMedCrossRef
3.
Zurück zum Zitat Bloor BC, Ward DS, Belleville JP, et al. Effects of intravenous dexmedetomidine in humans, II: hemodynamic changes. Anesthesiology. 1992;77:1134–42.PubMedCrossRef Bloor BC, Ward DS, Belleville JP, et al. Effects of intravenous dexmedetomidine in humans, II: hemodynamic changes. Anesthesiology. 1992;77:1134–42.PubMedCrossRef
4.
Zurück zum Zitat Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136–42.PubMedCrossRef Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136–42.PubMedCrossRef
5.
Zurück zum Zitat Talke P, Tong C, Lee HW, et al. Effect of dexmedetomidine on lumbar cerebrospinal fluid pressure in humans. Anesth Analg. 1997;85:358–64.PubMedCrossRef Talke P, Tong C, Lee HW, et al. Effect of dexmedetomidine on lumbar cerebrospinal fluid pressure in humans. Anesth Analg. 1997;85:358–64.PubMedCrossRef
6.
Zurück zum Zitat Zornow MH, Scheller MS, Sheehan PB, Strant MAP, Matsumoto M. Intracranial pressure effects of dexmedetomidine in rabbits. Anesth Analg. 1992;75:232–7.PubMedCrossRef Zornow MH, Scheller MS, Sheehan PB, Strant MAP, Matsumoto M. Intracranial pressure effects of dexmedetomidine in rabbits. Anesth Analg. 1992;75:232–7.PubMedCrossRef
7.
Zurück zum Zitat Karlsson BR, Forsman M, Roald OK, et al. Effect of dexmedetomidine, a selective and potent α2-agonist, on cerebral blood flow and oxygen consumption during halothane anesthesia in dogs. Anesth Analg. 1990;71:125–9.PubMedCrossRef Karlsson BR, Forsman M, Roald OK, et al. Effect of dexmedetomidine, a selective and potent α2-agonist, on cerebral blood flow and oxygen consumption during halothane anesthesia in dogs. Anesth Analg. 1990;71:125–9.PubMedCrossRef
8.
Zurück zum Zitat Prielipp RC, Wall MH, Tobin JR, et al. Dexmedetomidine-induced sedation in volunteers decreases regional and global cerebral blood flow. Anesth Analg. 2002;95:1052–9.PubMedCrossRef Prielipp RC, Wall MH, Tobin JR, et al. Dexmedetomidine-induced sedation in volunteers decreases regional and global cerebral blood flow. Anesth Analg. 2002;95:1052–9.PubMedCrossRef
9.
Zurück zum Zitat Aryan HE, Box KW, Irahim D, et al. Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain Inj. 2006;20:791–8.PubMedCrossRef Aryan HE, Box KW, Irahim D, et al. Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain Inj. 2006;20:791–8.PubMedCrossRef
10.
Zurück zum Zitat Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J. 2004;97:451–5.PubMedCrossRef Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J. 2004;97:451–5.PubMedCrossRef
11.
Zurück zum Zitat Drummond JC, Dao AV, Roth DM, et al. Effect of dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate, and carbon dioxide response in normal humans. Anesthesiology. 2008;108:225–32.PubMed Drummond JC, Dao AV, Roth DM, et al. Effect of dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate, and carbon dioxide response in normal humans. Anesthesiology. 2008;108:225–32.PubMed
12.
Zurück zum Zitat Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Use of sedation and neuromuscular blockade in the treatment of severe pediatric traumatic brain injury (chapter 9). Pediatr Crit Care Med. 2003;4:S34–7. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Use of sedation and neuromuscular blockade in the treatment of severe pediatric traumatic brain injury (chapter 9). Pediatr Crit Care Med. 2003;4:S34–7.
13.
Zurück zum Zitat Spitzfaden AC, Jimenez DF, Tobias JD. Propofol for sedation and control of intracranial pressure in children. Pediatr Neurosurg. 1999;31:194–200.PubMedCrossRef Spitzfaden AC, Jimenez DF, Tobias JD. Propofol for sedation and control of intracranial pressure in children. Pediatr Neurosurg. 1999;31:194–200.PubMedCrossRef
14.
Zurück zum Zitat Wheeler A, Bothwell M, Tobias JD. Prevention of medication withdrawal following laryngotracheoplasty. Am J Pain Manage. 2005;15:15–21. Wheeler A, Bothwell M, Tobias JD. Prevention of medication withdrawal following laryngotracheoplasty. Am J Pain Manage. 2005;15:15–21.
15.
Zurück zum Zitat Hammer GB, Philip BM, Schroeder AR, et al. Prolonged infusion of dexmedetomidine for sedation following tracheal resection. Pediatr Anesth. 2005;15:616–20.CrossRef Hammer GB, Philip BM, Schroeder AR, et al. Prolonged infusion of dexmedetomidine for sedation following tracheal resection. Pediatr Anesth. 2005;15:616–20.CrossRef
16.
Zurück zum Zitat Chrysostomou C, Zeballos T. Use of dexmedetomidine in a pediatric heart transplant patient. Pediatr Cardiol. 2005;26:651–4.PubMedCrossRef Chrysostomou C, Zeballos T. Use of dexmedetomidine in a pediatric heart transplant patient. Pediatr Cardiol. 2005;26:651–4.PubMedCrossRef
17.
Zurück zum Zitat Chrysostomou C, Di Filippo S, Manrique AM, et al. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med. 2006;7:126–31.PubMedCrossRef Chrysostomou C, Di Filippo S, Manrique AM, et al. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med. 2006;7:126–31.PubMedCrossRef
18.
Zurück zum Zitat Walker J, Maccallum M, Fischer C, et al. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res. 2006;27:206–10.PubMed Walker J, Maccallum M, Fischer C, et al. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res. 2006;27:206–10.PubMed
19.
Zurück zum Zitat Mason KP, Zgleszewski SE, Dearden JL, et al. Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth Analg. 2006;103:57–62.PubMedCrossRef Mason KP, Zgleszewski SE, Dearden JL, et al. Dexmedetomidine for pediatric sedation for computed tomography imaging studies. Anesth Analg. 2006;103:57–62.PubMedCrossRef
20.
Zurück zum Zitat Mason KP, Zurakowski D, Zgleszewski SE, et al. High dose dexmedetomidine as the sole sedative for pediatric MRI. Pediatr Anesth. 2008;18:403–11.CrossRef Mason KP, Zurakowski D, Zgleszewski SE, et al. High dose dexmedetomidine as the sole sedative for pediatric MRI. Pediatr Anesth. 2008;18:403–11.CrossRef
21.
Zurück zum Zitat Mason KP, Zgleszewski SE, Prescilla R, et al. Hemodynamic effects of dexmedetomidine sedation for CT imaging studies. Pediatr Anesth. 2008;18:393–402.CrossRef Mason KP, Zgleszewski SE, Prescilla R, et al. Hemodynamic effects of dexmedetomidine sedation for CT imaging studies. Pediatr Anesth. 2008;18:393–402.CrossRef
22.
Zurück zum Zitat Hammer GB, Drover DR, Cao H, et al. The effects of dexmedetomidine on cardiac electrophysiology in children. Anesth Analg. 2008;106:79–83.PubMedCrossRef Hammer GB, Drover DR, Cao H, et al. The effects of dexmedetomidine on cardiac electrophysiology in children. Anesth Analg. 2008;106:79–83.PubMedCrossRef
Metadaten
Titel
High-dose Dexmedetomidine-induced Hypertension in a Child with Traumatic Brain Injury
verfasst von
Gwen Erkonen
Fred Lamb
Joseph D. Tobias
Publikationsdatum
01.12.2008
Verlag
Humana Press Inc
Erschienen in
Neurocritical Care / Ausgabe 3/2008
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-008-9102-y

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