• Jamie Burns, Kevin Jackson, Kathy A Sheehy, Julia C Finkel, and Zenaide M Quezado.
• 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's Research Institute , Washington, DC.
• J Palliat Med. 2017 Jul 1; 20 (7): 779-783.

ObjectiveTo evaluate the effect of dexmedetomidine infusions in patients with advanced malignancies, advanced heart disease, or after stem cell transplantation (SCT), who during end-of-life care had pain and/or agitation unresponsive to conventional therapies.BackgroundPediatric patients with intractable advanced malignancies, end-stage congenital heart diseases, or after SCT can suffer a great deal during end of life. Pain, drowsiness, fatigue, irritability, and worrying are experienced frequently, considered distressing, and are strongly associated with reductions in health-related quality-of-life scores. While opioids are the mainstay of analgesic therapy, in some patients, increasing opioid use can be ineffective and can be associated with increasing pain during end of life. Dexmedetomidine, a α2-adrenoreceptor agonist with sedative and analgesic properties but without respiratory depressant effects, has been shown to reduce opioid requirement and to facilitate opioid weaning.MethodsObservational cohort study of consecutive patients treated with dexmedetomidine during end of life in a pediatric hospital. Primary outcomes included pain scores and morphine-equivalent intake.ResultsWe identified nine patients [median age 8 (interquartile range; IQR 0.55-17 years)] who during end of life had received dexmedetomidine infusions. In these patients, dexmedetomidine infusions had a median duration of two days (IQR 1.5-12 days) and were associated with significant (p < 0.001) reductions in pain scores and a trend toward decreasing morphine-equivalent intake. There were no hemodynamic changes requiring vasoactive or anticholinergic agents.ConclusionsThese preliminary findings of beneficial effects of dexmedetomidine support the hypothesis that dexmedetomidine has a role in palliative care of children and adolescents during end of life.

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