A retrospective evaluation of the relationship between dexmedetomidine dosage and propofol sparing in pediatric oncology sedation

Children with acute lymphoblastic leukemia (ALL) exposed to high cumulative doses of propofol may be at increased risk for adverse neurocognitive outcomes. Dexmedetomidine has demonstrated potential neuroprotective effects in experimental and preclinical studies and has a consistent propofol-sparing effect. However, the relationship between DEX dose and the magnitude of propofol sparing remains incompletely characterized. This study aimed to evaluate the association between DEX dose and propofol requirements during pediatric procedural sedation. This retrospective observational study included children with ALL undergoing lumbar puncture and/or bone marrow aspiration under sedation with DEX and propofol. The association between DEX dose and total weight-adjusted propofol requirements was assessed using a linear mixed-effects model. Data on drug dosages, vital parameters, and adverse events were collected and analyzed. A total of 212 procedural sedations in 36 patients were analyzed. After adjustment for body weight, procedure type, and procedure duration, each 1 µg/kg increase in dexmedetomidine dose was associated with 0.87 mg/kg reduction in propofol requirements (95% CI -1.50 to -0.24; p = 0.0074). Under the linear model, the protocol relevant contrast from 1.0 to 1.5 µg/kg corresponds to an estimated 0.44 mg/kg lower propofol requirement (95% CI, − 0.75 to − 0.12). Higher body weight was associated with lower weight-adjusted propofol requirements, whereas longer procedure duration and bone marrow aspiration were associated with higher propofol requirements. Higher dexmedetomidine doses were associated with lower propofol requirements during procedural sedation in children with ALL, indicating an inverse dose–response association within the evaluated dose range. Not applicable. High cumulative doses of propofol administered to pediatric patients may be associated with adverse long-term neurocognitive outcomes, while experimental studies suggest potential neuroprotective properties of dexmedetomidine. Higher dexmedetomidine doses were associated with lower propofol requirements during procedural sedation in children with ALL. These findings provide real-world evidence of an inverse dose–response association between dexmedetomidine dose and propofol requirements within the evaluated dose range.