DEXMEDETOMIDINE FOR SEDATION IN CHILDREN – A NARRATIVE REVIEW OF CLINICAL EVIDENCE, SAFETY CONSIDERATIONS, AND EMERGING THERAPEUTIC ROLES

Abstract

Dexmedetomidine is a highly selective alfa2-adrenergic agonist increasingly used in pediatric anesthesia and intensive care because of its unique sedative profile and minimal respiratory depressive effects. This narrative summarizes current evidence regarding the pharmacology, pharmacokinetics, clinical efficacy, safety profile and emerging applications of dexmedetomidine in pediatric patients. Current literature supports the use of dexmedetomidine in multiple clinical settings, including procedural sedation, perioperative management, and pediatric intensive care. The drug has demonstrated efficacy in reducing opioid requirements, preventing emergence agitation and delirium, and providing effective sedation while preserving spontaneous respiration. However, its use remains associated with dose-dependent cardiovascular adverse effects, particularly bradycardia and hypotension, requiring individualized dosing and careful monitoring, especially in neonates and infants due to age-related pharmacokinetic variability. Emerging evidence suggests potential neuroprotective and organ-protective properties, although robust pediatric clinical data remains limited. Novel applications and alternative administration routes continue to expand the potential role of dexmedetomidine in pediatric practice. Overall, dexmedetomidine represents a versatile and valuable sedative agent in pediatric medicine, though further high-quality studies are needed to optimize dosing strategies and better define long-term safety outcomes.