Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study

Abstract

Background: Anesthetic regimens using dexmedetomidine and short-acting opioids have been suggested as potential alternatives to sevoflurane-based anesthesia in children. The primary aim of this study is to compare demographics, intraoperative characteristics, and complications of general anesthetics in which dexmedetomidine and opioids were used without sevoflurane, or in combination with a low sevoflurane concentration, in children 36 months old and younger. The secondary aim is to evaluate intraoperative bispectral index (BIS) values when available in these patients. Methods: General anesthetics performed between January 1, 2017, and May 1, 2018, in children 2 years and younger who received dexmedetomidine and remifentanil, with or without sevoflurane, were identified. Additional anesthetics performed during this time in children 36 months and younger who received dexmedetomidine and opioids and had BIS monitoring were also identified. Charts were reviewed for demographic and intraoperative variables, including drug administration and hemodynamic data.

Suspected opioid‐induced hyperalgesia in an infant following surgery: A case report

“…While several studies show that single, short exposures to anaesthesia do not impact neurocognitive development, the effects of prolonged or multiple exposures remain unknown 1–3 . To spare these agents in young children when surgery cannot be postponed, administration of high‐doses of opioids, which have not been implicated, during surgery is a possible strategy 4 . While the use of opioids in children is common and often necessary, there may be unexpected consequences in the acute setting when high‐doses are administered, which is a less favoured strategy compared to multimodal regimens 5 …”

“…[1][2][3] To spare these agents in young children when surgery cannot be postponed, administration of high-doses of opioids, which have not been implicated, during surgery is a possible strategy. 4 While the use of opioids in children is common and often necessary, there may be unexpected consequences in the acute setting when high-doses are administered, which is a less favoured strategy compared to multimodal regimens. 5 We present the case of an infant who received high-dose fentanyl to spare other anaesthetics during surgery and developed severe agitation postoperatively due to suspected opioid induced hyperalgesia (OIH).…”