NM-212
Is Dexmedetomidine the Answer to Neonate Anesthesia?
Lee J, Castro P
Cleveland Clinic, Beachwood, Ohio, USA
Introduction
Recent studies have demonstrated the neurotoxic effects of many commonly used anesthetic agents to the immature brain in animal models; the question remains as to how this translates to the pediatric population. Dexmedetomidine is a sedative medication that does not seem to have potential neurotoxic effects in the developing brain. We present the case of a neonate who underwent two different anesthetics in the interventional radiology suite with dexmedetomidine as the primary sedative.
Case Discussion
The patient is a full term neonate with a history of congenital bilateral hydronephrosis, posterior urethral valve obstruction and hypertension. He had a nephrostomy tube exchange on two separate occasions. Given the patient’s age, high likelihood of undergoing multiple anesthetics for future procedures and history of laryngomalacia, we formulated a safe anesthetic plan that would minimize his exposure to anesthetic agents.
At 12 days, the patient underwent anesthesia for a nephrostogram with nephrostomy tube exchange. He received supplemental oxygen via nasal cannula and remained spontaneously breathing. We administered 1 mcg/kg of dexmedetomidine over 15 minutes prior to placing him on a dexmedetomidine infusion at 1 mcg/kg/hr for the whole procedure. The patient was appropriately sedated with optimal conditions for the IR team to complete the procedure without difficulty.
The patient returned for the same procedure at 23 days of age and we followed a similar anesthetic plan. An awake PIV was placed. A 1 mcg/kg bolus of dexmedetomidine was given over 15 minutes, followed by a dexmedetomidine infusion at 1 mcg/kg/hr, which was titrated to effect. A total of 30 minutes passed from start time until the patient was adequately sedated. A total of 0.5 mcg/kg of IV fentanyl was given in divided doses. Prior to incision the IR physician administered local anesthetic to the surgical site. The patient was anesthetized safely while avoiding airway instrumentation.
Discussion
There is growing concern within the medical community whether exposure to anesthetic agents will cause changes to the developing human brain. Until definitive evidence can be obtained, one important question is what can be done in the interim to help attenuate the potential adverse effects of children undergoing anesthesia.
Dexmedetomidine was considered the ideal choice in our neonate who would need multiple anesthetics for the treatment of his underlying disease. This drug has exhibited potential neuroprotective effects in preclinical studies involving inhaled anesthetics and propofol. The lack of potential neurotoxicity combined with its analgesic, sedative and anxiolytic properties made it a good choice. Furthermore, with the patient’s history of laryngomalacia we wanted to avoid any significant respiratory depression. Carrying out two successful anesthetics as described above shows that with careful planning and the patience of all involved staff, dexmedetomidine may be a good alternative for neonates coming for certain procedures.
References:
Perez-Zoghbi, JF et al. Dexmedetomidine-mediated neuroprotection against sevoflurane-induced neurotoxicity extends to several brain regions in neonatal rats. Br J Anaesth 2017, 119(3): 506-516.
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