Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease

Objective: In this report, we describe the use of dexmedetomidine as the primary sedative agent while performing invasive procedures in infants and toddlers with congenital heart disease who are breathing spontaneously. Design: Retrospective case review. Setting: University Hospital, pediatric cardiac intensive care unit. Patients: Six spontaneously breathing children, five infants and one toddler, all with congenital heart disease, who received dexmedetomidine as the primary sedative agent while undergoing an invasive procedure. Interventions: None. Measurements and Main Results: Six patients with congenital heart disease, age 3 days-29 months were included. Five of the patients were < 6 months of age. Each patient underwent an invasive procedure including central venous line placement, chest tube insertion, fiberoptic bronchoscopy, and femoral cut-down for Broviac placement. All patients were breathing spontaneously throughout their procedure. Dexmedetomidine was used as the primary sedative agent during the procedure with additional sedation provided with low dose ketamine for patient movement in three of the six patients. The average dexmedetomidine dose used was 1.5 mu g/kg (1-3 mu g/kg). An additional low dose of ketamine, 0.7 mg/kg (0.3-1.5 mg/kg), was used in 50% of the patients. All patients breathed spontaneously without significant desaturation throughout the procedure, and although there was a trend toward lower blood pressure and heart rate, all patients remained warm and well perfused. Each of the six procedures was successfully completed without any associated complications. Conclusions: Our experience suggests that invasive procedures can be successfully performed in spontaneously breathing infants and toddlers with congenital heart disease using dexmedetomidine alone or in combination with low dose ketamine.