Journal of Pediatric Perspectives

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

News

Dexmedetomidine versus Fentanyl in Children Undergoing Central Venous Catheter Placement at the Pediatric Intensive Care Unit: A Randomized Double-Blind Clinical Trial

Document Type : original article

Authors

1 Department of Clinical Pharmacy, Faculty of pharmacy, Mazandaran University of Medical Sciences, Sari, Iran

2 Pediatric Infectious Diseases Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

3 Pharmaceutical Sciences Research Center, Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran

Abstract

Background: The amount of sedation required for children in the pediatric intensive care unit (PICU) is a usually challenging issue. Fentanyl is a commonly used sedative in PICU, but respiratory depression limits its use. Dexmedetomidine (DEX) is an effective sedative and anesthetic agent with negligible respiratory depression and hemodynamic stability.This study was aimed to assess the effects of using DEX as a sedative in comparison to fentanyl.
Methods: We conducted a randomized double-blind clinical trial on children aging 1 month to 18 years who were required central venous catheter at PICU. The patients were randomized into the DEX and fentanyl (loading dose 1 mcg/kg and 1 mcg/kg/h for continuous infusion) groups. The primary outcome was defined as the time to achieve Ramsay Sedation Scale (RSS) ≥3, along with the safety outcome.
Results: A total of 55 patients were recruited for the analysis between July 7 and December 30, 2020. The two groups were comparable at baseline. There was no statistical difference in the number of patients (63% in DEX and 50% in fentanyl group p=0.39) and the time of reaching RSS≥3 (10 min for DEX and 15 min for fentanyl group p=0.098). Furthermore, the catheterization time between the two groups was not different when the agents were administered individually or with propofol (15 min for DEX and 17.5 min for fentanyl, p=0.225, and 22.5 for DEX and 30 min for fentanyl group, p=0.075 respectively); neither was the safety profile significantly different in the two groups.
Conclusions: This study found that DEX as a primary sedative is non-inferior to fentanyl, and it could facilitate sedation alone or in combination with propofol.

Keywords

References
  1. Bagwell CE, Salzberg AM, Sonnino RE, Haynes JH. Potentially lethal complications of central venous catheter placement. Journal of pediatric surgery. 2000; 35(5):709-13.
  2. Mumtaz H, Williams V, Hauer-Jensen M, Rowe M, Henry-Tillman R S, Heaton K, Mancino AT, Muldoon RL, Klimberg VS, Broadwater JR, Westbrook KC, Lang NP. Central venous catheter placement in patients with disorders of hemostasis. The American journal of surgery. 2000; 180(6):503-6.
  3. Hayden JC, Breatnach C, Doherty DR, Healy M, Howlett MM, Gallagher PJ, Cousins G. Efficacy of α2-agonists for sedation in pediatric critical care: a systematic review. Pediatric Critical Care Medicine. 2016; 17(2):e66-e75.
  4. Schmidt AP, Valinetti EA, Bandeira D, Bertacchi MF, Simões CM, Auler J. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Pediatric Anesthesia. 2007; 17(7):667-74.
  5. Tobias JD. Bradycardia during dexmedetomidine and therapeutic hypothermia. Journal of intensive care medicine. 2008; 23(6):403-8.
  6. Cortinez LI, Hsu YW, Sum-Ping ST, Young C, Keifer JC, Macleod D, Robertson KM, Wright DR, Moretti EW, Somma J. Dexmedetomidine pharmacodynamics: Part II: Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. The Journal of the American Society of Anesthesiologists. 2004; 101(5):1077-83.
  7. Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. Southern medical journal. 2004; 97(5):451-6.
  8. Aydogan MS, Korkmaz MF, Ozgül U, Erdogan MA, Yucel A, Karaman A, Togal T, Durmus M, Colak C. Pain, fentanyl consumption, and delirium in adolescents after scoliosis surgery: dexmedetomidine vs midazolam. Pediatric Anesthesia. 2013; 23(5):446-52.
  9. Heard CM, Joshi P, Johnson K. Dexmedetomidine for pediatric MRI sedation: a review of a series of cases. Pediatric Anesthesia. 2007; 17(9):888-92.
  10. Mason KP, Zgleszewski SE, Dearden JL, Dumont RS, Pirich MA, Stark CD, D'Angelo P, Macpherson S, Fontaine PJ, Connor L, Zurakowski D. Dexmedetomidine for pediatric sedation for computed tomography imaging studies. LWW; 2006.
  11. Shutes BL, Gee SW, Sargel CL, Fink KA, Tobias JD. Dexmedetomidine as a single continuous sedative during noninvasive ventilation: typical usage, hemodynamic effects, and withdrawal. Pediatric critical care medicine. 2018; 19(4):287-97.
  12. Mason KP, Zurakowski D, Zgleszewski SE, Robson CD, Carrier M, Hickey PR, Dinardo JA. High dose dexmedetomidine as the sole sedative for pediatric MRI. Pediatric Anesthesia. 2008; 18(5):403-11.
  13. Khalil SN, Matuszczak ME, Maposa D, Bolos ME, Lingadevaru HS, Chuang AZ. Presurgical fentanyl vs caudal block and the incidence of adverse respiratory events in children after orchidopexy. Pediatric anesthesia. 2009; 19(12):1220-5.
  14. Gupta A, Kaur R, Malhotra R, Kale S. Comparative evaluation of different doses of propofol preceded by fentanyl on intubating conditions and pressor response during tracheal intubation without muscle relaxants. Pediatric Anesthesia. 2006; 16(4):399-405.
  15. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, Hagberg CA, Caplan RA, Benumof JL, Berry FA, Blitt CD, Bode RH, Cheney FW, Connis RT, Guidry OF, Nickinovich DG, Ovassapian A. American Society of Anesthesiologists Task Force on Management of the Difficult Airway Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013; 118(2):251-70.
  16. Bong CL, Tan J, Lim S, Low Y, Sim SW, Rajadurai VS, Khoo PC, Allen J, Meaney M, Koh WP. Randomized controlled trial of dexmedetomidine sedation vs general anesthesia for inguinal hernia surgery on perioperative outcomes in infants. British journal of anaesthesia. 2019; 122(5):662-70.
  17. Jooste EH, Hammer GB, Reyes CR, atkade VK, Szmuk P. Phase IV, Open-Label, Safety Study Evaluating the Use of Dexmedetomidine in Pediatric Patients Undergoing Procedure-Type Sedation. Frontiers in pharmacology. 2017; 8:529.
  18. Al Taher WM, Mansour EE, El Shafei MN. Comparative study between novel sedative drugs (dexmedetomidine) versus midazolam–propofol for conscious sedation in pediatric patients undergoing oro-dental procedures. Egyptian Journal of Anaesthesia. 2010; 26(4):299-304.
  19. Prasad S, Simha PP, Jagadeesh A. Comparative study between dexmedetomidine and fentanyl for sedation during mechanical ventilation in postoperative pediatric cardiac surgical patients. Indian journal of anaesthesia. 2012; 56(6):547.
  20. Mondal S, Ghosh S, Bhattacharya S, Choudhury B, Mallick S, Prasad A. Comparison between dexmedetomidine and fentanyl in intubation conditions during awake fiberoptic bronchoscopy: A randomized double-blind prospective study. Journal of anaesthesiology, clinical pharmacology. 2015; 31(2):212.
  21. Ming S, Xie Y, Du X, Huang H, Fan Y, Liang Q, Xie Y. Effect of dexmedetomidine on perioperative hemodynamics and organ protection in children with congenital heart disease: A randomized controlled trial. Medicine. 2021; 100(1).
  22. Ali AR, El Ghoneimy MN. Dexmedetomidine versus fentanyl as adjuvant to propofol: comparative study in children undergoing extracorporeal shock wave lithotripsy. European Journal of Anaesthesiology| EJA. 2010; 27(12):1058-64.
  23. Erickson SJ, Millar J, Anderson BJ, Festa MS, Straney L, Shehabi Y, Long DA. Dexmedetomidine Sedation in Mechanically Ventilated Critically Ill Children: A Pilot Randomized Controlled Trial. Pediatric Critical Care Medicine. 2020; 21(9):e731-e9.
  24. Erdil F, Demirbilek S, Begec Z, Ozturk E, Ulger MH, Ersoy MO. The effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children. Anesthesia and intensive care. 2009; 37(4):571-6.
  25. Olutoye O, Kim T, Giannoni C, Stayer S. Dexmedetomidine as an analgesic for pediatric tonsillectomy and adenoidectomy. Pediatric anaesthesia. 2007; 17(10):1007-8.
  26. Potts AL, Anderson BJ, Warman GR, Lerman J, Diaz SM, Vilo S. Dexmedetomidine pharmacokinetics in pediatric intensive care–a pooled analysis. Pediatric Anesthesia. 2009; 19(11):1119-29.
  27. Chauhan R, Luthra L, Sethi S, Panda N, Meena SC, Bhatia V, Bloria SD. A prospective randomized controlled trial using propofol or dexmedetomidine for conscious sedation in pediatric patients undergoing sclerotherapy. Journal of Pediatric Neurosciences. 2020; 15(4):379.
  28. Yang X, Hu Z, Peng F, Chen G, Zhou Y, Yang Q, Yang X Wang M. Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials. Frontiers in pediatrics. 2020; 8.
  29. Daverio M, Sperotto F, Zanetto L, Coscini N, Frigo AC, Mondardini MC, Amigoni A. Dexmedetomidine for Prolonged Sedation in the PICU: A Systematic Review and Meta-Analysis. Pediatric Critical Care Medicine. 2020; 21(7):e467-e74.
Journal of Pediatric Perspectives
Volume 10, Issue 5
May 2022
Pages 16005-16016
Files
Share
How to cite
Statistics