Sedation in neonatal emergencies: ¿dexmedetomidine, the ideal agent?

Abstract

Introduction Dexmedetomidine is a highly selective and potent alpha 2 agonist drug with analgesic, amnesic, sedative and sympatholytic properties that make it an important auxiliary agent in emergency procedures. The advantages of dexmedetomidine are unique, it produces conscious sedation and analgesia without respiratory depression. It has been reported to have neuroprotective effects in various models of brain injury, however, there is increasing evidence on organ protective effects against ischemic and hypoxic injury, including cardioprotection and renoprotection. Neuroprotection benefits neonates and delayed cardiac conduction, an adverse effect, may be beneficial for arrhythmias after congenital heart surgery.

 Objective: To provide the best scientific evidence of dexmedetomidine in relation to its advantages in the mentioned age group.

 Material and methods: A systematic review of the scientific literature published in the period 2015-2020 was carried out. The following sites were searched using the following terms: "anesthesia", "dexmedetomidine", "newborn", "sedation", "mechanical ventilation", "respiratory insufficiency", "pharmacology", "adverse effects" in bases Data: Medline, Minerva Anestesiologica, The Journal of Pediatric Pharmacology and Therapeutics, Anesthesia & Analgesia, Pediatric Critical Care Medicine and Current Opinion in Anaesthesiology.

 Results: The best scientific evidence suggests that dexmedetomidine is an agent of great potential in neonatal and pediatric age, for sedation management with preservation of respiratory autonomy, which would make it an ideal agent in this age group.

 Conclusions: The theoretical advantages of dexmedetomidine in the target age group make it a highly useful drug; neonates are mostly susceptible to respiratory depression due to opioids or benzodiazepines in sedation due to their still immature anatomical and upper respiratory center variations. Although its safety and efficacy have not been proven with large randomized clinical trials, it is projected as a quality alternative for sedation in the described age group.