Off-label use of dexmedetomidine in paediatric anaesthesiology: an international survey of 791 (paediatric) anaesthesiol
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Off-label use of dexmedetomidine in paediatric anaesthesiology: an international survey of 791 (paediatric) anaesthesiologists Camille E. van Hoorn 1,2 & Robert B. Flint 3,4 & Justin Skowno 5 & Paul Davies 6 & Thomas Engelhardt 7,8 & Kirk Lalwani 9 & Olutoyin Olutoye 10 & Erwin Ista 11,12 & Jurgen C. de Graaff 1 Received: 29 April 2020 / Accepted: 15 October 2020 # The Author(s) 2020
Abstract Purpose The purpose of this international study was to investigate prescribing practices of dexmedetomidine by paediatric anaesthesiologists. Methods We performed an online survey on the prescription rate of dexmedetomidine, route of administration and dosage, adverse drug reactions, education on the drug and overall experience. Members of specialist paediatric anaesthesia societies of Europe (ESPA), New Zealand and Australia (SPANZA), Great Britain and Ireland (APAGBI) and the USA (SPA) were consulted. Responses were collected in July and August 2019. Results Data from 791 responders (17% of 5171 invitees) were included in the analyses. Dexmedetomidine was prescribed by 70% of the respondents (ESPA 53%; SPANZA 69%; APAGBI 34% and SPA 96%), mostly for procedural sedation (68%), premedication (46%) and/or ICU sedation (46%). Seventy-three percent had access to local or national protocols, although lack of education was the main reason cited by 26% of the respondents not to prescribe dexmedetomidine. The main difference in dexmedetomidine use concerned the age of patients (SPA primarily < 1 year, others primarily > 1 year). The dosage varied widely ranging from 0.2–5 μg kg−1 for nasal premedication, 0.2–8 μg kg−1 for nasal procedural sedation and 0–4 μg kg−1 intravenously as adjuvant for anaesthesia. Only ESPA members (61%) had noted an adverse drug reaction, namely bradycardia. Conclusion The majority of anaesthesiologists use dexmedetomidine in paediatrics for premedication, procedural sedation, ICU sedation and anaesthesia, despite the off-label use and sparse evidence. The large intercontinental differences in prescribing dexmedetomidine call for consensus and worldwide education on the optimal use in paediatric practice. Keywords Anaesthesia . Paediatrics . Dexmedetomidine . Pharmacology . Drug prescriptions . Off-label use Supplementry Information The online version of this article (https:// doi.org/10.1007/s00228-020-03028-2) contains supplementary material, which is available to authorized users. * Camille E. van Hoorn [email protected] 1
2
Department of Anaesthesiology, Erasmus University Medical Centre -Sophia Children’s Hospital, Rotterdam, The Netherlands Department of Paediatric Surgery, Erasmus University Medical Centre -Sophia Children’s Hospital, PO Box: 2060, 3000 CB Rotterdam, The Netherlands
3
Division of Neonatology, Department of Paediatrics, Erasmus University Medical Centre -Sophia Children’s Hospital, Rotterdam, The Netherlands
4
Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, The Netherlands
5
Department of Anaesthesiolo
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