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Objectives: Our primary objectives were to describe the dosing and safety of our dexmedetomidine protocol in children undergoing outpatient electroencephalograms (EEG).
Study Design: Retrospective chart review evaluating children (0 to 18 years) who received dexmedetomidine during an outpatient pediatric EEG procedure from September 2011 through June 2015.
Methods: The dexmedetomidine protocol includes an initial bolus of 1 mcg/kg/dose followed by an additional 0.5 mcg/kg/dose if not adequately sedated. Dexmedetomidine is then started at an infusion rate of 0.5 mcg/kg/hr. Demographics and medications for Autism Spectrum, Attention Deficit Hyperactivity Disorder and seizure disorders were collected. Loading dose(s) and infusion rates along with vital signs at baseline and every 5-10 minutes until the procedure was completed was documented. Interventions for hypotension, bradycardia and respiratory depression were also recorded.
Results: All twenty patients (age 1-13 years) received an initial dexmedetomidine bolus of 1 mcg/kg/dose. A second loading dose was required in 70% (n=14) with an average dose of 0.82 mcg/kg (range: 0.5 to 1 mcg/kg/dose). Nine patients (64.3%) received a second loading dose of 1 mcg/kg. Dexmedetomidine’s average starting infusion rate was 0.66 mcg/kg/hr (range: 0.5 to 0.8 mcg/kg/hr). Ten patients (50%) experienced a notable event: three had tachycardia, one had hypotension, and eight had hypertension with no interventions required. One patient had an elevated respiratory rate at baseline and throughout the procedure.
Conclusions: All patients followed the protocol in receiving the initial dexmedetomidine bolus. Patients who required a second dose along with the initial continuous infusion rate were dosed above the recommended protocol. The notable events recorded did not require interventions during dexmedetomidine infusion or EEG procedure. This may suggest that revisions for higher dosing to the protocol may be warranted.