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Utilização da dexmedetomidina como sedativo em idade pediátrica : estudo clínico retrospetivo e revisão teórica
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Introdução: A dexmedetomidina é um agonista α2 seletivo aprovado para sedação em adultos, mas que carece de aprovação formal em crianças. Os dados existentes sugerem um perfil de eficácia e segurança similar ao verificado nos adultos, mas são limitados. Este trabalho pretende adicionar informação relevante sobre a utilidade do uso da dexmedetomidina em idade pediátrica, através da análise de dados dos doentes submetidos a este fármaco na Unidade de Cuidados Intensivos Pediátricos (UCIP) do Hospital de Santa Maria (HSM).
Métodos: Realizou-se um estudo clínico retrospetivo através da revisão dos processos clínicos dos doentes internados na UCIP do HSM que foram medicados com dexmedetomidina. Foram colhidos dados demográficos, relacionados com o internamento (motivo e duração) e com a perfusão do fármaco (tipo de ventilação no início e fim, motivo de início, dose, desmame, efeitos adversos, motivo de interrupção, sedoanalgesia concomitante).
Resultados: Analisaram-se dados de 17 processos. A dexmedetomidina foi iniciada para sedoanalgesia primária em 58,8% dos doentes e para rotação de fármacos nos restantes. A incidência de efeitos adversos foi de 11,8%, nomeadamente hipotensão e bradicardia, tendo sido revertidos com suspensão do fármaco ou redução da dose. Não houve registo de síndrome de abstinência em nenhum doente. A dexmedetomidina foi usada isoladamente em 1 doente. O fármaco mais frequentemente associado foi o midazolam (64,7%), seguido dos opióides. O grupo com dexmedetomidina para sedoanalgesia primária fez em média mais 1,2 (± 0,6) fármacos para sedoanalgesia concomitante. No grupo com dexmedetomidina para rotação de fármacos, a taxa média de redução das doses da sedoanalgesia concomitante foi de 56%, tendo sido máxima para a morfina (72%), seguida do midazolam (61%).
Conclusões: A dexmedetomidina parece ser um fármaco seguro e eficaz em idade pediátrica, podendo contribuir para a menor utilização e redução das doses de outros sedoanalgésicos e respetivos efeitos adversos.
Introduction: Dexmedetomidine is a selective α2-agonist that is approved for sedation in adults but lacks formal approval in children. The existing data suggests a safety and efficacy profile similar to what is seen in adults, but is limited. This study aims to add relevant data on the utility of dexmedetomidine in the pediatric population, through the analysis of registries from patients submitted to this drug at Santa Maria’s Hospital (HSM) Pediatric Intensive Care Unit (UCIP). Methods: A clinical retrospective study was conducted by reviewing the registries from the patients admitted at the HSM’s UCIP that were medicated with dexmedetomidine. Demographic, admission-related (motive and duration) and drug perfusion-related data (type of ventilation in the beginning and end, reason to start, dosage, weaning-off, adverse effects, motive for suspension, concomitant sedoanalgesia) were collected. Results: Data from 17 clinical registries were analyzed. Dexmedetomidine was initiated for primary sedoanalgesia in 58,8% of the patients and for drug rotation in the rest. The incidence of adverse effects was 11,8%, namely hypotension and bradycardia, which were reversed with drug suspension or dose reduction. There were no records of dexmedetomidine withdrawal syndrome. Dexmedetomidine was used as the only sedative in 1 patient. The most common drug associated to dexmedetomidine was midazolam (64,7%), followed by opioids. The group of patients with dexmedetomidine for primary sedation took on average 1,2 (± 0,6) additional sedoanalgesic drugs. In the group of patients with dexmedetomidine for drug rotation, the average rate of reduction of concomitant sedoanalgesia dose was 56%. The reduction rate was maximum with morphine (72%), followed by midazolam (61%). Conclusions: Dexmedetomidine appears to be a safe and efficient drug in the pediatric population and might contribute for a decrease in use and dosage of other sedoanalgesic drugs and their adverse effects.
Introduction: Dexmedetomidine is a selective α2-agonist that is approved for sedation in adults but lacks formal approval in children. The existing data suggests a safety and efficacy profile similar to what is seen in adults, but is limited. This study aims to add relevant data on the utility of dexmedetomidine in the pediatric population, through the analysis of registries from patients submitted to this drug at Santa Maria’s Hospital (HSM) Pediatric Intensive Care Unit (UCIP). Methods: A clinical retrospective study was conducted by reviewing the registries from the patients admitted at the HSM’s UCIP that were medicated with dexmedetomidine. Demographic, admission-related (motive and duration) and drug perfusion-related data (type of ventilation in the beginning and end, reason to start, dosage, weaning-off, adverse effects, motive for suspension, concomitant sedoanalgesia) were collected. Results: Data from 17 clinical registries were analyzed. Dexmedetomidine was initiated for primary sedoanalgesia in 58,8% of the patients and for drug rotation in the rest. The incidence of adverse effects was 11,8%, namely hypotension and bradycardia, which were reversed with drug suspension or dose reduction. There were no records of dexmedetomidine withdrawal syndrome. Dexmedetomidine was used as the only sedative in 1 patient. The most common drug associated to dexmedetomidine was midazolam (64,7%), followed by opioids. The group of patients with dexmedetomidine for primary sedation took on average 1,2 (± 0,6) additional sedoanalgesic drugs. In the group of patients with dexmedetomidine for drug rotation, the average rate of reduction of concomitant sedoanalgesia dose was 56%. The reduction rate was maximum with morphine (72%), followed by midazolam (61%). Conclusions: Dexmedetomidine appears to be a safe and efficient drug in the pediatric population and might contribute for a decrease in use and dosage of other sedoanalgesic drugs and their adverse effects.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Dexmedetomidina Crianças Sedação Anestesia Cuidados intensivos Pediatria