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A cannabinoid-intoxicated child treated with dexmedetomidine: a case report.

Cipriani F, Mancino A, Pulitanò SM, Piastra M, Conti G - J Med Case Rep (2015)

Bottom Line: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives.The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ(9)-tetrahydrocannabinol.Its properties and potential to allow for "cooperative" sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. flora.cipriani@yahoo.com.

ABSTRACT

Introduction: In the last 20 years, the rate of exposure to marijuana has increased dramatically, even in the pediatric population. Effects of intoxication are variable, more severe neurological symptoms can be observed following ingestion, thus hospital or intensive care unit admission is often required. Usually cannabinoids intoxicated patients are treated with administration of benzodiazepines or opioids, accepting the related risk of intubation and mechanical ventilation. Dexmedetomidine is a highly selective α2-adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives. To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient.

Case presentation: A 19-month-old Caucasian boy was presented to our emergency department. At the time of his arrival, he was somnolent with paroxysms of agitation, breathing spontaneously and hemodynamically stable. The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ(9)-tetrahydrocannabinol. The patient was admitted to the pediatric intensive care unit and treated with a continuous infusion of dexmedetomidine.

Conclusions: Dexmedetomidine is a fairly safe and effective antidote for pediatric marijuana or natural cannabinoid exposures. Its properties and potential to allow for "cooperative" sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.

No MeSH data available.


Related in: MedlinePlus

Variation of heart rate (HR), systolic blood pressure (SBP) and Objective Pain Scale (OPS) score over time. The figure shows the trend of the patient’s vital signs (HR and SBP), which decreased after the start of the dexmedetomidine (Dex) continuous infusion (at 12 p.m.) and later remained stable. The graph also shows a zeroing of the OPS score because the child stayed quiet a few hours after the beginning of dexmedetomidine treatment. bpm, Beats per minute
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Fig1: Variation of heart rate (HR), systolic blood pressure (SBP) and Objective Pain Scale (OPS) score over time. The figure shows the trend of the patient’s vital signs (HR and SBP), which decreased after the start of the dexmedetomidine (Dex) continuous infusion (at 12 p.m.) and later remained stable. The graph also shows a zeroing of the OPS score because the child stayed quiet a few hours after the beginning of dexmedetomidine treatment. bpm, Beats per minute

Mentions: We admitted the patient to our pediatric intensive care unit (PICU) for monitoring and supportive treatment. The child had normal vital signs and was resting quietly for most of the time; however, these periods of calm were interrupted by sudden-onset agitated outbursts of violent behavior. First, we tried to control these phases with non-pharmacological measures: quiet ambience in the room, toys and colors, music and videos, presence of parents and gentle wrapping of the child in the bed. At a later stage, we tried to control his agitation by administering an intravenous bolus of midazolam (1mg), which was followed by a brief obstructive apnea episode. Considering our experience with dexmedetomidine and knowing it has no depressive respiratory effect [9], we started a dexmedetomidine continuous infusion, without any bolus, at the rate of 0.4μg/kg/hr and increased the rate progressively up to 0.7μg/kg/hr. The clinical effects are shown in Table 1 and Fig. 1. The patient’s episode of agitation disappeared with the dexmedetomidine continuous infusion, and he was quiet and cooperative. His vital sign parameters stabilized (Fig. 1), and his SpO2 stayed around 97 % to 100 % with spontaneous breathing on room air. After a 24-hour infusion, we progressively reduced dexmedetomidine until it was stopped while observing the patient’s reaction. He was calm, had a full recovery of consciousness and his vital signs were stable. The patient was transferred to the pediatric general ward.Table 1


A cannabinoid-intoxicated child treated with dexmedetomidine: a case report.

Cipriani F, Mancino A, Pulitanò SM, Piastra M, Conti G - J Med Case Rep (2015)

Variation of heart rate (HR), systolic blood pressure (SBP) and Objective Pain Scale (OPS) score over time. The figure shows the trend of the patient’s vital signs (HR and SBP), which decreased after the start of the dexmedetomidine (Dex) continuous infusion (at 12 p.m.) and later remained stable. The graph also shows a zeroing of the OPS score because the child stayed quiet a few hours after the beginning of dexmedetomidine treatment. bpm, Beats per minute
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4490763&req=5

Fig1: Variation of heart rate (HR), systolic blood pressure (SBP) and Objective Pain Scale (OPS) score over time. The figure shows the trend of the patient’s vital signs (HR and SBP), which decreased after the start of the dexmedetomidine (Dex) continuous infusion (at 12 p.m.) and later remained stable. The graph also shows a zeroing of the OPS score because the child stayed quiet a few hours after the beginning of dexmedetomidine treatment. bpm, Beats per minute
Mentions: We admitted the patient to our pediatric intensive care unit (PICU) for monitoring and supportive treatment. The child had normal vital signs and was resting quietly for most of the time; however, these periods of calm were interrupted by sudden-onset agitated outbursts of violent behavior. First, we tried to control these phases with non-pharmacological measures: quiet ambience in the room, toys and colors, music and videos, presence of parents and gentle wrapping of the child in the bed. At a later stage, we tried to control his agitation by administering an intravenous bolus of midazolam (1mg), which was followed by a brief obstructive apnea episode. Considering our experience with dexmedetomidine and knowing it has no depressive respiratory effect [9], we started a dexmedetomidine continuous infusion, without any bolus, at the rate of 0.4μg/kg/hr and increased the rate progressively up to 0.7μg/kg/hr. The clinical effects are shown in Table 1 and Fig. 1. The patient’s episode of agitation disappeared with the dexmedetomidine continuous infusion, and he was quiet and cooperative. His vital sign parameters stabilized (Fig. 1), and his SpO2 stayed around 97 % to 100 % with spontaneous breathing on room air. After a 24-hour infusion, we progressively reduced dexmedetomidine until it was stopped while observing the patient’s reaction. He was calm, had a full recovery of consciousness and his vital signs were stable. The patient was transferred to the pediatric general ward.Table 1

Bottom Line: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives.The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ(9)-tetrahydrocannabinol.Its properties and potential to allow for "cooperative" sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.

View Article: PubMed Central - PubMed

Affiliation: Pediatric Intensive Care Unit, Department of Intensive Care and Anesthesia, Agosto Gemelli University Polyclinic, Catholic University of Rome, Largo Agostino Gemelli 1, 00168, Rome, Italy. flora.cipriani@yahoo.com.

ABSTRACT

Introduction: In the last 20 years, the rate of exposure to marijuana has increased dramatically, even in the pediatric population. Effects of intoxication are variable, more severe neurological symptoms can be observed following ingestion, thus hospital or intensive care unit admission is often required. Usually cannabinoids intoxicated patients are treated with administration of benzodiazepines or opioids, accepting the related risk of intubation and mechanical ventilation. Dexmedetomidine is a highly selective α2-adrenergic receptor agonist, with no effect on the respiratory drive and pattern and produces a good level of sedation, allowing to avoid the administration of other sedatives. To our knowledge, this is the first reported case of dexmedetomidine use to support a cannabis intoxicated patient.

Case presentation: A 19-month-old Caucasian boy was presented to our emergency department. At the time of his arrival, he was somnolent with paroxysms of agitation, breathing spontaneously and hemodynamically stable. The results of all investigations were negative, but the result of the immunochemical screening of his urine was positive for Δ(9)-tetrahydrocannabinol. The patient was admitted to the pediatric intensive care unit and treated with a continuous infusion of dexmedetomidine.

Conclusions: Dexmedetomidine is a fairly safe and effective antidote for pediatric marijuana or natural cannabinoid exposures. Its properties and potential to allow for "cooperative" sedation make it a more attractive choice with fewer side effects than benzodiazepines or opioids.

No MeSH data available.


Related in: MedlinePlus