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.