Sir, In recent years, there has been increased interest in dexmedetomidine (DEX), in both anaesthesiology and intensive care [1]. This alpha-2 receptor agonist has been implicated as the drug of choice for sedation of children after cardiac surgery [2], which is undoubtedly associated with its lack of depressive effects, moderate sedative and analgesic action and beneficial antiarrhythmic effects.We would like to share our experiences with this drug, which has been used in the Paediatric Intensive Care Unit since 2013 after the approval by the hospital therapeutic committee. Until June 2014, dexmedetomidine (Dexdor, Orion Pharma, Espoo, Finland) was used 38 times in 33 children with respiratory failure, as an infusion in an initial dose of 0.5−1.4 µg kg -1 h -1 . The drug was administered to discontinue the supply of earlier agents (mainly opioids) during weaning from a ventilator or to change the mode of sedation. During treatment, the following parameters were recorded: heart rate, respiration rate, SpO 2, arterial pressure (invasive or non-invasive method). Moreover, diuresis and parameters of acid-base balance were monitored. Changes in parameters exceeding 20% of the baseline value were considered adverse. The data are presented in Table 1.The drug was administered as follows: postoperatively in 12 children; during pneumonia treatment -6 children; after injuries -2 children; sepsis -2 children; bronchopulmonary dysplasia -2 children; and, comprising 1 case each, bronchiolitis, airway burns, congenital heart defect, cardiomyopathy, pulmonary hypertension, toxic epidermal necrolysis (Lyell's syndrome), spinal muscular atrophy, encephalopathy and intracranial haemorrhage. Although in 8 cases, DEX was the only sedative used, in other cases, it was an element of multi-drug sedation: midazolam was used in 22 children, morphine in 15, propofol in 14, ketamine in 4, magnesium sulphate in 2, along with fentanyl, clonazepam, fenobarbital and clonidine, comprising 1 case each. After the inclusion of DEX, morphine was discontinued in 11 cases and mechanical ventilation was successfully completed in 9 children. In total, during DEX infusion, ventilation was discontinued and trachea extubated in 24 children (63%) (following completion of earlier infusions of opioids and other sedatives). In 3 children, DEX was discontinued due to no beneficial effects. In 2 children, a decrease in the heart rate by 20% of the baseline value was observed. Bradycardia subsided after a dose reduction or withdrawal of the drug. One patient died during DEX treatment, an event which was unrelated to its use, the cause of death being acute myeloid leukemia and intracranial haemorrhage. One child mistakenly received too high a dose of DEX (8.6 then 4.3 µg kg -1 h -1 ), for 11 days in total. Nonetheless, no cardiovascular disorders or other adverse effects, including withdrawal symptoms, were observed.Initially, DEX was recommended for sedation lasting maximum 24 h; currently, its longer use has also been reported, even for many weeks in the dose...

A 36-year-old pregnant lady was admitted at 26 weeks gestation with abdominal pain radiating to the groin and back. Physical examination, biopsy of the cervix and magnetic resonance imaging (MRI) confirmed cervical carcinoma. As the patient wished to continue with the pregnancy, a decision was made to perform elective caesarean section at 34 weeks. Due to persistent severe pain despite systemic analgesics, the decision to insert a tunnelled epidural catheter was made in order to provide long term analgesia. Repeated boluses of 0.2% ropivacaine or 0.2-0.25% bupivacaine with morphine, depending on numerical rating scale (NRS) values, were administered. Co-medication consisted of intravenous acetaminophen. Preterm delivery by caesarean section at 32 weeks gestation was performed because the patient went into labour. The epidural catheter was in situ for 32 days with no complications.