Dexmedetomidine for Sedation of Neonates with HIE Undergoing Therapeutic Hypothermia: A Single-Center Experience

O’Mara, Keliana; Weiss, Michael D.

doi:10.1055/s-0038-1669938

Cited by 45 publications

(21 citation statements)

References 18 publications

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“…Dexmedetomidine, another α 2 -adrenergic agonist commonly used for sedation in intensive care settings, is also effective in inducing thermal tolerance ( 38 ). A single center retrospective study published in 2018 described their experience using dexmedetomidine for sedation in 19 infants with HIE during therapeutic hypothermia who tolerated the drug without significant cardiovascular instability ( 42 ). A 2020 publication reports the pharmacokinetics of dexmedetomidine in 7 infants with HIE during TH ( 15 ) who also tolerated it well.…”

Section: Discussionmentioning

confidence: 99%

Clonidine for sedation in infants during therapeutic hypothermia with neonatal encephalopathy: pilot study

Gauda

Chavez‐Valdez²,

Northington³

et al. 2021

J Perinatol

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Objective: To determine a safe dose of clonidine (CLON) to be used in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Study Design: A pilot prospective study was performed to determine the effect of CLON on autonomic parameters, the pharmacokinetics (PK) of CLON, and the amount of morphine (MOR) given “as needed” for shivering and agitation in a cohort of infants (n=12) with HIE undergoing TH compared to a historical control group (n=28). Results: The CLON group received less “as needed” MOR than the MOR-only group for agitation/shivering (p < 0.001), and the CLON vs MOR-only group spent 92% vs 79% of cooling time at the target core body temperature (CBT; p = 0.03, CLON vs MOR). Conclusions: Intravenous CLON (1mcg/kg Q8h) is well tolerated in infants treated with TH for HIE. CLON stabilizes CBT in the ideal range during cooling which may be optimal for neuroprotection.

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Section: Discussionmentioning

confidence: 99%

Clonidine for sedation in infants during therapeutic hypothermia with neonatal encephalopathy: pilot study

Gauda

Chavez‐Valdez²,

Northington³

et al. 2021

J Perinatol

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“…In the periphery, activation of post-synaptic α 2 -adrenergic receptors inhibits lipolysis and non-shivering thermogenesis in brown fat [ 14 , 15 ]. The physiologic effects of α 2 -adrenergic agonists, predominantly dexmedetomidine, on temperature regulation and heat generation have led to its use to prevent shivering following anesthetic care and during therapeutic hypothermia [ 16 - 18 ].…”

Section: Discussionmentioning

confidence: 99%

Hypothermia Following Spinal Anesthesia in an Infant: Potential Impact of Intravenous Dexmedetomidine and Intrathecal Clonidine

Arends

Tobias

2019

J Med Cases

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The α 2 -adrenergic agonists (dexmedetomidine and clonidine) have been used in several different clinical scenarios in infants and children including sedation during mechanical ventilation, procedural sedation, supplementation of postoperative analgesia, prevention of emergence delirium, control of post-anesthesia shivering, treatment of withdrawal and prolonging of duration of neuraxial anesthesia. Hemodynamic effects including bradycardia and hypotension remain the predominant adverse effects reported with the α 2 -adrenergic agonists. We report hypothermia following intravenous sedation with dexmedetomidine and spinal anesthesia with a combination of bupivacaine and clonidine in a 2-month-old infant. The potential mechanisms involved are reviewed, the causal relationship between hypothermia and α 2 -adrenergic agonists is explored and interventions to avoid its development are presented.

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“…Like morphine, the pharmacokinetics of dexmedetomidine are altered such that clearance is reduced by 56% following experimental hypoxia-ischemia and an additional 33% during TH [ 100 ]. A retrospective cohort study identified an effective dose of 0.3 mcg/kg/h (range 0.2–0.5 mcg/kg/h) during TH with no evidence of altered respiratory status, bradycardia, or hypotension at these lower doses [ 101 ]. Further, full enteral feedings were achieved at a mean of 6 days of life, sooner than historic controls treated with fentanyl infusion.…”

Section: Sedation Of the Term Neonate During Therapeutic Hypothermiamentioning

confidence: 99%

Practical approaches to sedation and analgesia in the newborn

2020

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The prevention, assessment, and treatment of neonatal pain and agitation continues to challenge clinicians and researchers. Substantial progress has been made in the past three decades, but numerous outstanding questions remain. In this setting, clinicians must establish safe and compassionate standardized practices that consider available efficacy data, long-term outcomes, and research gaps. Novel approaches with limited data must be carefully considered against historic standards of care with robust data suggesting limited benefit and clear adverse effects. This review summarizes available evidence while suggesting practical clinical approaches to pain assessment and avoidance, procedural analgesia, postoperative analgesia, sedation during mechanical ventilation and therapeutic hypothermia, and the issues of tolerance and withdrawal. Further research in all areas represents an urgent priority for optimal neonatal care. In the meantime, synthesis of available data offers clinicians challenging choices as they balance benefit and risk in vulnerable critically ill neonates.

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Dexmedetomidine for Sedation of Neonates with HIE Undergoing Therapeutic Hypothermia: A Single-Center Experience

Cited by 45 publications

References 18 publications

Clonidine for sedation in infants during therapeutic hypothermia with neonatal encephalopathy: pilot study

Clonidine for sedation in infants during therapeutic hypothermia with neonatal encephalopathy: pilot study

Hypothermia Following Spinal Anesthesia in an Infant: Potential Impact of Intravenous Dexmedetomidine and Intrathecal Clonidine

Practical approaches to sedation and analgesia in the newborn

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