Relationship between dexmedetomidine dose and plasma dexmedetomidine concentration in critically ill infants: a prospective observational cohort study

Abstract

BackgroundDexmedetomidine is a highly selective central α2-agonist used as a sedative in pediatric intensive care unit (PICU). However, little is known about the relationship between dexmedetomidine dose and its plasma concentration during long-term infusion. We have previously demonstrated that the sedative plasma dexmedetomidine concentration is moderately correlated with the administered dose in adults (r = 0.653, P = 0.001). We hypothesized that there would be a similar relationship between the sedative dexmedetomidine concentration and administered dose in infants.MethodsAll patients admitted to the PICU at Nagoya City University Hospital, Japan, between November 2012 and March 2013 were eligible for inclusion in the study. Plasma dexmedetomidine concentration was measured by ultra-performance liquid chromatography coupled with tandem mass spectrometry.ResultsWe measured the plasma dexmedetomidine concentration in 203 samples from 45 patients. Of these, 96 samples collected from 27 patients < 2 years old were included in this study. All patients received dexmedetomidine at 0.12–1.40 µg/kg/h. The median administration duration was 87.6 hours (range: 6–540 hours). Plasma dexmedetomidine concentration ranged from 0.07 to 3.17 ng/ml. Plasma dexmedetomidine concentration was not correlated with the administered dose (r = 0.273, P = 0.007). The approximate linear equation was y = 0.690x + 0.423.ConclusionsIn infants, plasma dexmedetomidine concentration did not exhibit any correlation with administered dose, which is not a reliable means of obtaining optimal plasma concentration.

Dexmedetomidine: an attractive adjunct to anesthesia

“…These reports suggest that dexmedetomidine should be used with caution in patients with certain conditions in which sympathetic function is suppressed or parasympathetic function is enhanced. Fujita et al [ 19 ] reported that plasma dexmedetomidine concentration is correlated with the infusion dose in critically ill adult patients, but not in children < 2 years old admitted to the pediatric ICU [ 20 ]. These reports emphasize the need for close monitoring, individualized treatment, and dose adjustment to achieve the desired clinical response when administering dexmedetomidine.…”