Off-label use of dexmedetomidine in paediatric anaesthesiology: an
international survey of 791 (paediatric) anaesthesiologists
Abstract
The aim of this international study is to gain information on
dexmedetomidine prescription by paediatric anaesthesiologists. We
composed an online survey containing questions about the prescription
rate of dexmedetomidine, administration route and dosage, adverse drug
reactions, education on the drug and overall experience. Members of
specialist paediatric anaesthesia societies of Europe (ESPA,n=849), New
Zealand and Australia (SPANZA,n=320), Great Britain and Ireland
(APAGBI,n=872) and the United States (SPA,n=3130) were e-mailed a link
to this survey; responses were collected July and August 2019. Eight
hundred and fifty-one invitees (851/5171,17%) responded, of whom 60 did
not report their countries and were therefore excluded from the
analyses. The ESPA members’ response rate was 25%, SPANZA35%,
APAGBI15% and SPA10%. Dexmedetomidine is prescribed by 70% of all
respondents (ESPA 121/229,53%;SPANZA 77/111,69%;APAGBI 44/129,34% and
SPA 310/322,96%) of whom 73% has access to mostly local protocols.
Differences in the use were mainly found in the age of the patients
receiving dexmedetomidine (SPA primarily <1 year, others
primarily >1 year). Members of SPANZA, APAGBI and SPA had
not noted adverse drug reactions, although 61% of ESPA members had
noted bradycardia. The majority of SPA respondents were not aware of any
contraindications, whereas members from all other societies were aware
of these. Although an on-label paediatric indication and clinical
evidence have yet been lacking, many anaesthesiologists use
dexmedetomidine in paediatrics for premedication, procedural sedation,
ICU sedation and anaesthesia. The large intercontinental differences in
dexmedetomidine prescription call for consensus and worldwide education
on the optimal use of dexmedetomidine in paediatric practice.