Incidence and predictors of hypertension during high-dose dexmedetomidine sedation for pediatric MRI

Abstract

This study reviewed the hypertensive response of a large population of children to high-dose dexmedetomidine sedation with the aim of determining the incidence and predictors of hypertension. When dexmedetomidine is used to provide sedation for children, fluctuations in blood pressure have been described in case reports. We report the incidence and predictors of hypertension in a large series of children who received dexmedetomidine. At our institution, a computerized database holds patient demographics, sedation outcomes, adverse events, and hemodynamic data for all children who receive dexmedetomidine sedation for radiological imaging studies. After Institutional Review Board approval, this database was reviewed. Three thousand five hundred twenty-two (3522) children received dexmedetomidine sedation between May 1, 2007 and December 31, 2008 for magnetic resonance imaging studies. Median age was 3.6 years (interquartile range: 1.8-5.9). A total of 172 patients (4.9%) developed hypertension, with a higher incidence in the younger age group (0-3 years) when compared to the older age groups (3-18 years) (P < 0.05). Multivariable logistic regression modeling confirmed that younger age (Wald test = 43.5 of 5 degrees of freedom, P < 0.001) and more than one bolus (Wald test = 22.7, P < 0.001) were highly significant predictors of the occurrence of hypertension. When high-dose dexmedetomidine is used for pediatric sedation for MR imaging, the incidence of hypertension is low. Hypertension is most likely to occur in children <1 year of age during the continuous infusion, after they have received more than one bolus of dexmedetomidine.