FREQUENCY OF WITHDRAWAL AFTER PROLONGED DEXMEDETOMIDINE INFUSION IN CHILDREN FOLLOWING CARDIAC SURGERY

Abstract

Background: Withdrawal-like symptoms have been reported after prolonged dexmedetomidine infusion in critically ill children. We estimated the frequency of a positive withdrawal assessment after infusion in children following cardiac surgery.

Methods: This observational study included 137 consecutive children aged 1–9 years following cardiac surgery at the Children’s Hospital, Lahore. Prolonged infusion was defined as more than 24 hours. Withdrawal was assessed during weaning and for 24 hours after stopping dexmedetomidine; the prespecified outcome was a Withdrawal Assessment Tool-1 (WAT-1) score of at least 3. Descriptive statistics and unadjusted subgroup comparisons were reported.

Results: Twenty-four of 137 children met the WAT-1 threshold (17.5%; exact 95% confidence interval, 11.6%–24.9%). Mean age was 4.39 years (standard deviation [SD] 2.24), and 90 (65.7%) were male. Positive assessments occurred in 19 of 47 girls (40.4%) and 5 of 90 boys (5.6%; reported P<0.001). Rates were 21.1% in children aged 4 years or younger and 13.1% in those older than 4 years (P=0.224). Mean infusion duration was 126.83 (SD 25.32) hours with a positive assessment and 124.53 (SD 22.83) hours without one (reported P=0.66).

Conclusions: Approximately one in six children had a positive WAT-1 assessment after prolonged dexmedetomidine infusion. As WAT-1 was validated primarily for opioid and benzodiazepine withdrawal, and concomitant drug exposure was not reported, these results should not be interpreted as dexmedetomidine-specific withdrawal incidence.