Jamie Burns1, Kevin Jackson1, Kathy A Sheehy1, Julia C Finkel1,2, Zenaide M Quezado1,2,3. 1. 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC. 2. 2 George Washington University School of Medicine and Health Sciences , Washington, DC. 3. 3 Center for Neuroscience Research, Children's National Health System, Children's Research Institute , Washington, DC.
Abstract
OBJECTIVE: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies. BACKGROUND: Pediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores. While opioids are the mainstay of analgesic therapy, in some patients, increasing opioid use can be ineffective and can be associated with increasing pain during end of life. Dexmedetomidine, a α2-adrenoreceptor agonist with sedative and analgesic properties but without respiratory depressant effects, has been shown to reduce opioid requirement and to facilitate opioid weaning. METHODS: Observational cohort study of consecutive patients treated with dexmedetomidine during end of life in a pediatric hospital. Primary outcomes included pain scores and morphine-equivalent intake. RESULTS: We identified nine patients [median age 8 (interquartile range; IQR 0.55-17 years)] who during end of life had received dexmedetomidine infusions. In these patients, dexmedetomidine infusions had a median duration of two days (IQR 1.5-12 days) and were associated with significant (p < 0.001) reductions in pain scores and a trend toward decreasing morphine-equivalent intake. There were no hemodynamic changes requiring vasoactive or anticholinergic agents. CONCLUSIONS: These preliminary findings of beneficial effects of dexmedetomidine support the hypothesis that dexmedetomidine has a role in palliative care of children and adolescents during end of life.
OBJECTIVE: To evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies. BACKGROUND: Pediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores. While opioids are the mainstay of analgesic therapy, in some patients, increasing opioid use can be ineffective and can be associated with increasing pain during end of life. Dexmedetomidine, a α2-adrenoreceptor agonist with sedative and analgesic properties but without respiratory depressant effects, has been shown to reduce opioid requirement and to facilitate opioid weaning. METHODS: Observational cohort study of consecutive patients treated with dexmedetomidine during end of life in a pediatric hospital. Primary outcomes included pain scores and morphine-equivalent intake. RESULTS: We identified nine patients [median age 8 (interquartile range; IQR 0.55-17 years)] who during end of life had received dexmedetomidine infusions. In these patients, dexmedetomidine infusions had a median duration of two days (IQR 1.5-12 days) and were associated with significant (p < 0.001) reductions in pain scores and a trend toward decreasing morphine-equivalent intake. There were no hemodynamic changes requiring vasoactive or anticholinergic agents. CONCLUSIONS: These preliminary findings of beneficial effects of dexmedetomidine support the hypothesis that dexmedetomidine has a role in palliative care of children and adolescents during end of life.
Authors: Veerle Piette; Kim Beernaert; Joachim Cohen; Nele S Pauwels; Anne-Lore Scherrens; Jutte van der Werff Ten Bosch; Luc Deliens Journal: Pediatr Res Date: 2020-07-09 Impact factor: 3.756