Tobias Joseph D
Department of Anesthesiology, University of Missouri, Columbia, USA.
J Opioid Manag. 2008 Jul-Aug;4(4):187-91. doi: 10.5055/jom.2008.0024.
This retrospective study reports a cohort of pediatric patients in whom subcutaneous dexmedetomidine was used to treat or prevent drug withdrawal following prolonged sedation in the Pediatric Intensive Care Unit setting. There were seven patients ranging in age from 6 months to 3.75 years and in weight from 4.8 to 17.7 kg. The dexmedetomidine infusion before switching to subcutaneous administration varied from 0.8 to 1.4 microg/kg/h. Four of the patients had received dexmedetomidine in conjunction with an opioid as part of a sedation regimen during mechanical ventilation. In these four patients, the duration of the intravenous dexmedetomidine infusion varied from 4 to 10 days. In the three other patients, an intravenous dexmedetomidine infusion was used to treat withdrawal following the prolonged use of an opioid and/or a benzodiazepine. In these three patients, the duration of the intravenous dexmedetomidine varied from 3 to 5 days. Following the switch to subcutaneous dexmedetomidine, the infusion was gradually decreased by 0.1 microg/kg/h every 12 h. Subcutaneous access was maintained, and subcutaneous dexmedetomidine was administered for 4 to 7 days. No problems with the subcutaneous access were noted during treatment. No patient exhibited behavior suggestive of withdrawal during the use of subcutaneous dexmedetomidine. The maximum modified Finnegan score in the seven patients varied from 3 to 7. Our preliminary experience suggests that dexmedetomidine can be administered by subcutaneous infusion without difficulty or alteration of its efficacy. This approach allows the administration of dexmedetomidine when peripheral venous access becomes problematic and may facilitate the removal of central venous catheters in patients recovering from critical illnesses. It also offers the possibility of using dexmedetomidine in settings where peripheral venous access is not available such as home palliative care.
这项回顾性研究报告了一组儿科患者，在儿科重症监护病房环境中，皮下注射右美托咪定用于治疗或预防长时间镇静后的药物戒断反应。共有7名患者，年龄从6个月至3.75岁，体重从4.8至17.7千克。转为皮下给药前右美托咪定的输注速率为0.8至1.4微克/千克/小时。其中4名患者在机械通气期间作为镇静方案的一部分，接受了右美托咪定与阿片类药物联合使用。在这4名患者中，静脉输注右美托咪定的持续时间为4至10天。另外3名患者在长时间使用阿片类药物和/或苯二氮䓬类药物后，使用静脉输注右美托咪定治疗戒断反应。在这3名患者中，静脉输注右美托咪定的持续时间为3至5天。转为皮下注射右美托咪定后，输注速率每12小时逐渐降低0.1微克/千克/小时。维持皮下给药途径，皮下注射右美托咪定持续4至7天。治疗期间未发现皮下给药途径出现问题。在使用皮下注射右美托咪定期间，没有患者表现出戒断相关行为。7名患者的最大改良芬尼根评分在3至7分之间。我们的初步经验表明，右美托咪定可以通过皮下输注给药，且无困难，疗效也未改变。这种方法在外周静脉通路出现问题时可给予右美托咪定，并且可能有助于从危重症恢复的患者拔除中心静脉导管。它还提供了在无法进行外周静脉通路的环境（如家庭姑息治疗）中使用右美托咪定的可能性。
