Dexmedetomidine Continuous Infusion to Maintain Sedation in Severely Agitated Adolescents in the Emergency Department

Study objectives Adolescents with severe agitation may require repeated administration of sedatives. We describe dexmedetomidine infusion as a novel bridge therapy for selected agitated adolescents awaiting psychiatric treatment and disposition. Methods We retrospectively studied adolescents (12 to 17 years) treated with dexmedetomidine infusion for severe agitation at our emergency department (ED) over a 16-month period. We abstracted demographics, sedatives administered, psychiatric therapy, type and frequency of adverse events, and ED disposition. Our primary outcome was the need for additional sedation despite dexmedetomidine. Results The median age of our 20 qualifying patients was 15 years. The median duration of dexmedetomidine infusion was 21 hours, with a median maximum dose of 1.6 mcg/kg per hour. During the infusion, 9 patients (45%, 95% confidence interval 26% to 66%) required additional sedation. One patient experienced desaturation responding to head repositioning and supplemental oxygen. Five patients were transferred to the pediatric ICU owing to the need of multiple sedatives. Conclusion Our preliminary results support the feasibility of dexmedetomidine infusion as bridge sedation for selected severely agitated adolescents awaiting psychiatric care and disposition.