Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children.

OBJECTIVE: Children often require sedation for lengthy noninvasive procedures. Conventional agents such as chloral hydrate, benzodiazepines, or barbiturates have been associated with sedation failure, respiratory depression, and paradoxic agitation. Dexmedetomidine is a newer alpha(2)-adrenergic receptor agonist with sedative properties and minimal respiratory depression. We hypothesized that it would be an effective agent for these procedures. DESIGN: Prospective case series. SETTING: Tertiary care children's hospital. PATIENTS: Children undergoing noninvasive procedures. INTERVENTIONS: Children were sedated with dexmedetomidine given as a bolus of 0.5-1.0 microg/kg over 5-10 mins followed by an infusion of 0.5-1.0 microg/kg/hr. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded. MEASUREMENTS AND MAIN RESULTS: Forty-eight patients, aged 6.9 +/- 3.7 yrs, were sedated. Fifteen received dexmedetomidine after failing sedation with chloral hydrate and/or midazolam. Sedation was induced with 0.92 +/- 0.36 microg/kg over 10.3 +/- 4.7 mins and maintained with an infusion of 0.69 +/- 0.32 microg/kg/hr. All procedures were completed. Heart rate, blood pressure, and respiratory rate decreased (p < .0001) but remained within normal limits for age. End-tidal CO(2) exceeded 50 mm Hg in seven of 404 measurements (1.7%). Mean recovery time was 84 +/- 42 mins and was significantly longer in the rescue (117 +/- 41 mins) vs. primary (69 +/- 34 mins) group (p < .0001). No patient developed agitation during recovery. CONCLUSIONS: Dexmedetomidine provided effective sedation in children undergoing noninvasive procedures and represents an alternative sedative choice for this population.

Validation of a noninvasive blood pressure monitoring device in normotensive and hypertensive pediatric intensive care patients.

OBJECTIVE: To evaluate the performance and to define limitations of a noninvasive blood pressure monitoring device in the critically ill pediatric population. METHOD: Patients were included in the study if they were admitted to the Pediatric Intensive Care Unit, were between the ages of 1 month and 18 years with wrist circumferences of > or =10 cm, and had an indwelling arterial line. Patients were excluded if their systolic blood pressure differed by > or =7.5% between their upper extremities. The measurements were collected simultaneously with those from an arterial line by a computer interfaced with the noninvasive blood pressure monitoring system and the patient's monitor. Heart rates were calculated from the recorded pulse waveforms of the arterial lines. Comparison analyses were performed via bias and precision plots of the blood pressure and heart rate data in addition to calculation of Pearson's correlation coefficients and concordance correlation coefficients. As a nonparametric method of comparison, the proportion of measurements that differed by greater than 10% was calculated. Results. Blood pressures and heart rates of 20 patients between the ages of 12 months and 17 years were monitored by a noninvasive blood pressure monitor for 30 min per patient. This data collection resulted in 2015 data points for each blood pressure and heart rate for comparison of methods. Concordance correlation coefficients were the following: systolic blood pressure, 0.93; diastolic blood pressure, 0.93; mean blood pressure, 0.94; and heart rate, 0.85. CONCLUSIONS: The noninvasive blood pressure monitor is capable of producing an accurate blood pressure measurement every 12-15 heartbeats in addition to providing a pulse waveform and digital display of the heart rate. Our study showed good agreement between the methods in the normotensive and hypertensive critically ill pediatric population with a wrist circumference limitation defined at > or =11 cm.