BJA Advance Access published online on March 31, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen070
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Pharmacokinetics of intravenous dexmedetomidine in children under 11 yr of age
1 Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Unit, Turku University Hospital, PO Box 52, FIN-20521 Turku, Finland
2 Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Hospital for Children and Adolescents, PO Box 281, FIN-00029 HUS, Helsinki, Finland
3 Department of Pharmacology and Clinical Pharmacology, University of Turku, FIN-20520 Turku, Finland
* Corresponding author. E-mail: sanna.vilo{at}tyks.fi
Background: Information has been very limited on the pharmacokinetics of the selective 
2-adrenoceptor agonist dexmedetomidine in children, particularly in children <2 yr of age.
Methods: Eight children aged between 28 days and 23 months and eight children aged between 2 and 11 yr undergoing either elective bronchoscopy or nuclear magnetic resonance imaging were included in the study. Dexmedetomidine 1 µg kg–1 was infused i.v. over 5 min. Blood samples for the measurement of plasma concentrations of dexmedetomidine were collected for 5 h after starting the infusion. Pharmacokinetic calculations were based on non-compartmental methods.
Results: In the two groups of paediatric patients, the median (range) values for total plasma clearance of dexmedetomidine were 17.4 (14.1–27.6) and 17.3 (9.3–22.5) ml kg–1 min–1, for volume of distribution at steady state 3.8 (1.9–4.6) and 2.2 (1.3–2.8) litre kg–1 (P<0.05), and for elimination half-life 139 (90–198) and 96 (69–140) min (P<0.05), respectively. The volume of distribution at steady state was negatively associated with subject age (r=–0.69, P<0.05).
Conclusions: To reach a certain plasma concentration, children younger than 2 yr of age evidently need larger initial doses of dexmedetomidine than the older children, as young children have a larger volume of distribution of the drug than older children and adults. Since the total plasma clearance of dexmedetomidine is independent of age, similar rates of infusion can be used in younger and older children to maintain a steady-state concentration of dexmedetomidine in plasma.
Keywords: children; pharmacokinetics, dexmedetomidine; sedation
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