Lee Michelle M, Caylor Karen, Gockenbach Nicole
J Pediatr Pharmacol Ther. 2020;25(2):104-110. doi: 10.5863/1551-6776-25.2.104.
To evaluate clonidine for preventing withdrawal from dexmedetomidine infusions and describe the incidence of withdrawal symptoms and adverse cardiovascular effects in critically ill pediatric patients.
Retrospective, descriptive study of patients in Advocate Children's Hospital-Park Ridge PICU who received dexmedetomidine infusion for ≥72 hours, followed by clonidine for ≥48 hours, between January 1, 2015, and August 31, 2017.
Thirty-eight patients (median age 4.3 years; IQR, 2-11.5) received 39 dexmedetomidine courses. The median duration of dexmedetomidine exposure was 7.6 days (IQR, 5-11.5) at an average dose of 1 mcg/kg/hr. The median dose of clonidine at initiation was 8.3 mcg/kg/day (for <50 kg) and 4.1 mcg/kg/day (for ≥50 kg). The most common oral administration frequency was every 8 hours. Dexmedetomidine infusions for 7 days or longer and a higher dexmedetomidine dose 24 hours prior to clonidine transition both correlated with increased initial clonidine doses. Fourteen patients (37%) had at least 1 WAT-1 score of ≥3 during the transition between dexmedetomidine and clonidine, with 7 (18%) requiring an increase in sedation. Adverse cardiovascular events were possibly attributable to dexmedetomidine and/or clonidine in 4 patients.
Patients receiving prolonged infusions of dexmedetomidine may transition to clonidine to help prevent withdrawal symptoms. Duration of dexmedetomidine infusion of 7 days or longer and higher average dexmedetomidine dose 24 hours prior to the transition are important considerations when determining the initial clonidine dose. Transition from dexmedetomidine to clonidine was found to be safe and efficacious in our patients, with minimal adverse effects.
评估可乐定预防右美托咪定输注停药反应的效果，并描述危重症儿科患者停药症状及心血管不良反应的发生率。
对2015年1月1日至2017年8月31日期间在Advocate儿童医院 - 帕克里奇儿科重症监护病房接受右美托咪定输注≥72小时，随后接受可乐定≥48小时的患者进行回顾性描述性研究。
38例患者（中位年龄4.3岁；四分位间距，2 - 11.5岁）接受了39个右美托咪定疗程。右美托咪定暴露的中位持续时间为7.6天（四分位间距，5 - 11.5天），平均剂量为1 mcg/kg/小时。起始时可乐定的中位剂量为8.3 mcg/kg/天（体重<50 kg者）和4.1 mcg/kg/天（体重≥50 kg者）。最常见的口服给药频率为每8小时一次。右美托咪定输注7天或更长时间以及在可乐定转换前24小时较高的右美托咪定剂量均与初始可乐定剂量增加相关。14例患者（37%）在右美托咪定和可乐定转换期间至少有1次WAT - 1评分≥3，其中7例（18%）需要增加镇静。4例患者的不良心血管事件可能归因于右美托咪定和/或可乐定。
接受长时间右美托咪定输注的患者可转换为可乐定以帮助预防停药症状。在确定初始可乐定剂量时，右美托咪定输注持续7天或更长时间以及转换前24小时较高的右美托咪定平均剂量是重要的考虑因素。在我们的患者中，发现从右美托咪定转换为可乐定是安全有效的，不良反应极少。
