Tags

Type your tag names separated by a space and hit enter

To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging.
Anesth Analg 2015; 121(2):479-85A&A

Abstract

BACKGROUND

Dexmedetomidine (Dex) appears to be very effective as a sole sedative for pediatric imaging when used at high doses, but at an increased risk of transient hypertension, hypotension, and bradycardia. There are no clinical evidence/guidelines to guide anesthesia providers as to whether patients should be pretreated with an anticholinergic. The aim of this study was to demonstrate the changes in hemodynamic parameters after Dex sedation attributed to receiving or not receiving an anticholinergic pretreatment and compare for any differences or similarities. A subgroups analysis was performed in children with Down syndrome (DS).

METHODS

In this retrospective descriptive study, we reviewed the records of 163 children receiving Dex anesthesia during MRI studies. Data analyzed included demographics, history of DS, and hemodynamics (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) following Dex loading and infusion and the administration of an anticholinergic (atropine or glycopyrrolate).

RESULTS

The mean age was 94.5 months, and 52 (32%) patients had DS. The generalized linear mixed-effects regression model showed a significant reduction in HR and SBP in all patients when no anticholinergic was administered compared with when it was administered. There was no significant change with DBP. During the scan period, the HR of the no-anticholinergic group decreased 26.6%, whereas that of the anticholinergic group decreased by only 16.7% from baseline (P < 0.01). The maximal SBP increased by a significantly greater percentage, compared with baseline, in the anticholinergic group in comparison with the no-anticholinergic group (20.2% vs 10.4%, respectively; P = 0.02). In the DS group, the difference in the maximal SBP change during the scan period was exaggerated, with a percentage increase that was 36 times larger in the anticholinergic group compared with the no-anticholinergic group (22% vs 0.6%, respectively; P< 0.01).

CONCLUSIONS

Administration of a prophylactic anticholinergic with Dex shows no advantage other than a transient clinically insignificant increase in HR and SBP, and it may precipitate transient exaggerated SBP in more patients compared with not using a prophylactic anticholinergic.

Authors+Show Affiliations

From the *Department of Anesthesia, Cincinnati Children's Hospital, Cincinnati, Ohio; and †Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital, Cincinnati, Ohio.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

25871854

Citation

Subramanyam, Rajeev, et al. "To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging." Anesthesia and Analgesia, vol. 121, no. 2, 2015, pp. 479-85.
Subramanyam R, Cudilo EM, Hossain MM, et al. To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging. Anesth Analg. 2015;121(2):479-85.
Subramanyam, R., Cudilo, E. M., Hossain, M. M., McAuliffe, J., Wu, J., Patino, M., ... Mahmoud, M. (2015). To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging. Anesthesia and Analgesia, 121(2), pp. 479-85. doi:10.1213/ANE.0000000000000765.
Subramanyam R, et al. To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging. Anesth Analg. 2015;121(2):479-85. PubMed PMID: 25871854.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging. AU - Subramanyam,Rajeev, AU - Cudilo,Elizabeth Maria, AU - Hossain,Mohamed Monir, AU - McAuliffe,John, AU - Wu,Junzheng, AU - Patino,Mario, AU - Gunter,Joel, AU - Mahmoud,Mohamed, PY - 2015/4/15/entrez PY - 2015/4/15/pubmed PY - 2015/10/9/medline SP - 479 EP - 85 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 121 IS - 2 N2 - BACKGROUND: Dexmedetomidine (Dex) appears to be very effective as a sole sedative for pediatric imaging when used at high doses, but at an increased risk of transient hypertension, hypotension, and bradycardia. There are no clinical evidence/guidelines to guide anesthesia providers as to whether patients should be pretreated with an anticholinergic. The aim of this study was to demonstrate the changes in hemodynamic parameters after Dex sedation attributed to receiving or not receiving an anticholinergic pretreatment and compare for any differences or similarities. A subgroups analysis was performed in children with Down syndrome (DS). METHODS: In this retrospective descriptive study, we reviewed the records of 163 children receiving Dex anesthesia during MRI studies. Data analyzed included demographics, history of DS, and hemodynamics (heart rate [HR], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) following Dex loading and infusion and the administration of an anticholinergic (atropine or glycopyrrolate). RESULTS: The mean age was 94.5 months, and 52 (32%) patients had DS. The generalized linear mixed-effects regression model showed a significant reduction in HR and SBP in all patients when no anticholinergic was administered compared with when it was administered. There was no significant change with DBP. During the scan period, the HR of the no-anticholinergic group decreased 26.6%, whereas that of the anticholinergic group decreased by only 16.7% from baseline (P < 0.01). The maximal SBP increased by a significantly greater percentage, compared with baseline, in the anticholinergic group in comparison with the no-anticholinergic group (20.2% vs 10.4%, respectively; P = 0.02). In the DS group, the difference in the maximal SBP change during the scan period was exaggerated, with a percentage increase that was 36 times larger in the anticholinergic group compared with the no-anticholinergic group (22% vs 0.6%, respectively; P< 0.01). CONCLUSIONS: Administration of a prophylactic anticholinergic with Dex shows no advantage other than a transient clinically insignificant increase in HR and SBP, and it may precipitate transient exaggerated SBP in more patients compared with not using a prophylactic anticholinergic. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/25871854/To_Pretreat_or_Not_to_Pretreat:_Prophylactic_Anticholinergic_Administration_Before_Dexmedetomidine_in_Pediatric_Imaging_ L2 - http://Insights.ovid.com/pubmed?pmid=25871854 DB - PRIME DP - Unbound Medicine ER -