INTRODUCTION: Dose reduction or discontinuation of dexmedetomidine, an alpha-2 adrenergic agonist sedative, after prolonged continuous administration may be associated with withdrawal syndrome. In adults, the adjunctive use of guanfacine, another alpha-2 adrenergic agonist, has been reported to facilitate the tapering and discontinuation of dexmedetomidine. Herein, we report the first pediatric patient in whom this approach was successfully used. CASE REPORT: A previously healthy 8-year-7-month-old girl developed febrile infection-related epilepsy syndrome and subsequently developed drug-resistant epilepsy and severe intellectual disability. She required tube feeding in the acute phase and underwent a gastrostomy at 9 years and 10 months of age. Continuous dexmedetomidine infusion was initiated immediately after surgery to maintain postoperative rest. Although tapering of dexmedetomidine was attempted starting on postoperative day 25, withdrawal syndrome, characterized predominantly by vomiting, fever, and agitation, occurred on three occasions each time the dose was reduced, necessitating re-escalation of dexmedetomidine to its original dose. When adjunctive guanfacine was introduced and dexmedetomidine tapering resumed on postoperative day 43, dexmedetomidine was successfully discontinued on postoperative day 49 without withdrawal symptoms. No adverse effects attributable to guanfacine such as hypotension or bradycardia were observed. DISCUSSION: Even in pediatric patients, adjunctive guanfacine may enable effective tapering and discontinuation of long-term dexmedetomidine while preventing withdrawal syndrome.
Okada et al. (Sat,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: