Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study
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...
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| Veröffentlicht in: | Pediatric anesthesia 2020-09, Vol.30 (9), p.1013-1019 |
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| container_title | Pediatric anesthesia |
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| creator | Efune, Proshad N. Longanecker, John M. Alex, Gijo Saynhalath, Rita Khan, Umar Rivera, Kevin Jerome, Aveline P. Boone, Weiwei Szmuk, Peter Vutskits, Laszlo |
| description | 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.
Results
A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety‐two patients received sevoflurane with a mean end‐tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1‐0.3, P |
| doi_str_mv | 10.1111/pan.13945 |
| format | Article |
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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.
Results
A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety‐two patients received sevoflurane with a mean end‐tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1‐0.3, P < .001) and more dexmedetomidine (median dose 0.9 μg/kg/h vs 0.3 μg/kg/h, difference of 0.6 μg/kg/h, 95% CI 0.4‐0.8, P < .001), and had a higher mean arterial pressure (median 53 mm Hg vs 42 mm Hg, difference of 11 mm Hg, 95% CI 8.1‐14.8, P < .001). Complications between the two groups were comparable. The median percent intraoperative time with BIS reading <60 was 71.6% (95% CI: 63.3%‐79.8%).
Conclusion
Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without <1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.13945</identifier><identifier>PMID: 32510703</identifier><language>eng</language><publisher>France: Wiley Subscription Services, Inc</publisher><subject>Anesthesia ; child < age ; Cohort analysis ; Drug dosages ; general anesthesia ; infant < age ; intravenous agents < drugs ; Narcotics ; neurodevelopment ; TIVA</subject><ispartof>Pediatric anesthesia, 2020-09, Vol.30 (9), p.1013-1019</ispartof><rights>2020 John Wiley & Sons Ltd</rights><rights>2020 John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3535-c823396649c5dae6957bfc97f0d50b7337c513b5a6fe0cbc07d4583a7dd2098f3</citedby><cites>FETCH-LOGICAL-c3535-c823396649c5dae6957bfc97f0d50b7337c513b5a6fe0cbc07d4583a7dd2098f3</cites><orcidid>0000-0002-9802-3483 ; 0000-0002-1076-5360</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.13945$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.13945$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32510703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Efune, Proshad N.</creatorcontrib><creatorcontrib>Longanecker, John M.</creatorcontrib><creatorcontrib>Alex, Gijo</creatorcontrib><creatorcontrib>Saynhalath, Rita</creatorcontrib><creatorcontrib>Khan, Umar</creatorcontrib><creatorcontrib>Rivera, Kevin</creatorcontrib><creatorcontrib>Jerome, Aveline P.</creatorcontrib><creatorcontrib>Boone, Weiwei</creatorcontrib><creatorcontrib>Szmuk, Peter</creatorcontrib><creatorcontrib>Vutskits, Laszlo</creatorcontrib><title>Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>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.
Results
A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety‐two patients received sevoflurane with a mean end‐tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1‐0.3, P < .001) and more dexmedetomidine (median dose 0.9 μg/kg/h vs 0.3 μg/kg/h, difference of 0.6 μg/kg/h, 95% CI 0.4‐0.8, P < .001), and had a higher mean arterial pressure (median 53 mm Hg vs 42 mm Hg, difference of 11 mm Hg, 95% CI 8.1‐14.8, P < .001). Complications between the two groups were comparable. The median percent intraoperative time with BIS reading <60 was 71.6% (95% CI: 63.3%‐79.8%).
Conclusion
Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without <1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.</description><subject>Anesthesia</subject><subject>child < age</subject><subject>Cohort analysis</subject><subject>Drug dosages</subject><subject>general anesthesia</subject><subject>infant < age</subject><subject>intravenous agents < drugs</subject><subject>Narcotics</subject><subject>neurodevelopment</subject><subject>TIVA</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kUtPxCAUhYnROONj4R8wJG500RFKaYu7ycRXYtSFs24o3DpMOqVCq_bfyzijCxMJCRC-e3LvOQidUDKhYV22splQJhK-g8Y0SUkkuIh3w51yHvE04SN04P2SEMriNN5HIxZzSjLCxuhz7gHbCmv4XIGGzq6MNg1g2WhsW2ON9lh63C0At86spBvCF_jw7ozCpgm7kk3nvwsG2zevWC1MrR00V3iKHXTO-hZUZ94BK7uwrsO-6_VwhPYqWXs43p6HaH5z_TK7ix6ebu9n04dIMc54pPKYMZGmiVBcS0gFz8pKiawimpMyYyxTnLKSy7QCokpFMp3wnMlM65iIvGKH6Hyj2zr71ofOi5XxCuo6jGF7X8TJ2omM5klAz_6gS9u7JnQXqCSlnIk4D9TFhlJhMu-gKrbGFJQU6ziKEEfxHUdgT7eKfRns_SV__A_A5Qb4MDUM_ysVz9PHjeQX2J2Uxw</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Efune, Proshad N.</creator><creator>Longanecker, John M.</creator><creator>Alex, Gijo</creator><creator>Saynhalath, Rita</creator><creator>Khan, Umar</creator><creator>Rivera, Kevin</creator><creator>Jerome, Aveline P.</creator><creator>Boone, Weiwei</creator><creator>Szmuk, Peter</creator><creator>Vutskits, Laszlo</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9802-3483</orcidid><orcidid>https://orcid.org/0000-0002-1076-5360</orcidid></search><sort><creationdate>202009</creationdate><title>Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study</title><author>Efune, Proshad N. ; Longanecker, John M. ; Alex, Gijo ; Saynhalath, Rita ; Khan, Umar ; Rivera, Kevin ; Jerome, Aveline P. ; Boone, Weiwei ; Szmuk, Peter ; Vutskits, Laszlo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3535-c823396649c5dae6957bfc97f0d50b7337c513b5a6fe0cbc07d4583a7dd2098f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesia</topic><topic>child < age</topic><topic>Cohort analysis</topic><topic>Drug dosages</topic><topic>general anesthesia</topic><topic>infant < age</topic><topic>intravenous agents < drugs</topic><topic>Narcotics</topic><topic>neurodevelopment</topic><topic>TIVA</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Efune, Proshad N.</creatorcontrib><creatorcontrib>Longanecker, John M.</creatorcontrib><creatorcontrib>Alex, Gijo</creatorcontrib><creatorcontrib>Saynhalath, Rita</creatorcontrib><creatorcontrib>Khan, Umar</creatorcontrib><creatorcontrib>Rivera, Kevin</creatorcontrib><creatorcontrib>Jerome, Aveline P.</creatorcontrib><creatorcontrib>Boone, Weiwei</creatorcontrib><creatorcontrib>Szmuk, Peter</creatorcontrib><creatorcontrib>Vutskits, Laszlo</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Efune, Proshad N.</au><au>Longanecker, John M.</au><au>Alex, Gijo</au><au>Saynhalath, Rita</au><au>Khan, Umar</au><au>Rivera, Kevin</au><au>Jerome, Aveline P.</au><au>Boone, Weiwei</au><au>Szmuk, Peter</au><au>Vutskits, Laszlo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2020-09</date><risdate>2020</risdate><volume>30</volume><issue>9</issue><spage>1013</spage><epage>1019</epage><pages>1013-1019</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><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.
Results
A total of 244 patients were identified. All but 22 patients received remifentanil. Ninety‐two patients received sevoflurane with a mean end‐tidal concentration of 0.84% (SD 0.43). Compared to the sevoflurane group, the nonsevoflurane group received more remifentanil (median dose 0.4 μg/kg/min vs 0.2 μg/kg/min, difference of 0.1 μg/kg/min, 95% CI 0.1‐0.3, P < .001) and more dexmedetomidine (median dose 0.9 μg/kg/h vs 0.3 μg/kg/h, difference of 0.6 μg/kg/h, 95% CI 0.4‐0.8, P < .001), and had a higher mean arterial pressure (median 53 mm Hg vs 42 mm Hg, difference of 11 mm Hg, 95% CI 8.1‐14.8, P < .001). Complications between the two groups were comparable. The median percent intraoperative time with BIS reading <60 was 71.6% (95% CI: 63.3%‐79.8%).
Conclusion
Dexmedetomidine and opioids can effectively be used in young children as an alternative total intravenous anesthesia technique with or without <1 minimum alveolar concentration of sevoflurane. Bispectral index monitoring reveals a likely sufficient depth of hypnosis.</abstract><cop>France</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32510703</pmid><doi>10.1111/pan.13945</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9802-3483</orcidid><orcidid>https://orcid.org/0000-0002-1076-5360</orcidid></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Anesthesia child < age Cohort analysis Drug dosages general anesthesia infant < age intravenous agents < drugs Narcotics neurodevelopment TIVA |
| title | Use of dexmedetomidine and opioids as the primary anesthetic in infants and young children: A retrospective cohort study |
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