Haenecour Astrid S, Seto Winnie, Urbain Charline M, Stephens Derek, Laussen Peter C, Balit Corrine R
Department of Critical Care Medicine (ASH, WS, PCL, CRB), The Hospital for Sick Children, Toronto, Canada; Department of Pharmacy (WS), The Hospital for Sick Children, Toronto, Canada; Department of Diagnostic Imaging and Neuroscience & Mental Health Program (CMU), The Hospital for Sick Children Research Institute, Toronto, Canada; Department of Clinical research services (DS), The Hospital for Sick Children, Toronto, Canada; and University of Toronto (DRB, PCL, WS), Toronto, Ontario, Canada.
J Pediatr Pharmacol Ther. 2017 Nov-Dec;22(6):453-460. doi: 10.5863/1551-6776-22.6.453.
To characterise the incidence, symptoms and risk factors for withdrawal associated with prolonged dexmedetomidine infusion in paediatric critically ill patients.
Retrospective chart review in the paediatric intensive care unit and the cardiac critical care unit of a single tertiary children's hospital. Patients up to 18 years old, who received dexmedetomidine for longer than 48 hours were included.
A total of 52 patients accounted for 68 unique dexmedetomidine treatment courses of more than 48 hours. We identified 24 separate episodes of withdrawal in the 68 dexmedetomidine courses (incidence 35%). Of these episodes 38% occurred in patients who were weaned from dexmedetomidine alone while the remaining occurred in patients who had concurrent weans of opioids and/or benzodiazepines. Most common symptoms were agitation, fever, vomiting/retching, loose stools and decreased sleep. The symptoms occurred during the latter part of the wean or after discontinuation of dexmedetomidine. A cumulative dose of dexmedetomidine of 107 mcg/kg prior to initiation of wean was more likely associated with withdrawal (this equates to a dexmedetomidine infusion running at 1 mcg/kg/hr over 4 days). Duration of opioid use was an additional risk factor for withdrawal. The use of clonidine, as a transition from dexmedetomidine, did not protect against withdrawal (p = 1).
A withdrawal syndrome may occur after prolonged infusion of dexmedetomidine. As all our patients were also exposed to opioids this may be affected by the duration of opioid use. We identified a cumulative dose of 107 micrograms/kg of dexmedetomidine beyond which withdrawal symptoms were more likely (which equates to 4 days of use at a dose of 1 mcg/kg/hr). A protocol for weaning should be considered in this circumstance.
描述儿科重症患者长时间输注右美托咪定后戒断反应的发生率、症状及危险因素。
在一家三级儿童医院的儿科重症监护病房和心脏重症监护病房进行回顾性病历审查。纳入18岁及以下接受右美托咪定治疗超过48小时的患者。
共有52例患者接受了68个疗程超过48小时的右美托咪定治疗。在68个右美托咪定疗程中，我们识别出24例单独的戒断事件（发生率35%）。其中38%的事件发生在仅停用右美托咪定的患者中，其余事件发生在同时停用阿片类药物和/或苯二氮䓬类药物的患者中。最常见的症状是烦躁、发热、呕吐/干呕、腹泻和睡眠减少。这些症状出现在撤药后期或右美托咪定停药后。撤药前右美托咪定累积剂量达107 mcg/kg更易发生戒断反应（这相当于以1 mcg/kg/hr的速度输注4天）。阿片类药物使用时间是戒断反应的另一个危险因素。使用可乐定作为从右美托咪定的过渡药物并不能预防戒断反应（p = 1）。
长时间输注右美托咪定后可能发生戒断综合征。由于我们所有患者也都使用了阿片类药物，这可能受阿片类药物使用时间的影响。我们确定右美托咪定累积剂量达107微克/千克后更易出现戒断症状（相当于以1 mcg/kg/hr的剂量使用4天）。在这种情况下应考虑制定撤药方案。
