Off-label use of dexmedetomidine in anaesthesiology in South Africa

Abstract

Background Dexmedetomidine is registered for limited use in anaesthesiology and intensive care, however, it is known to be used off-label. The extent of this off-label use in South Africa is not known. This study aims to describe the off-label use of dexmedetomidine in anaesthesiology in South Africa. Methods The study was a prospective, contextual, descriptive study using convenience sampling. A self-administered survey was distributed at the national South African Society of Anaesthesiologists Congress as well as the Anaesthetic Foundation Refresher Course in 2018. Results A total of 416 surveys were distributed and 188 (45.2%) were returned of which 184 (44.2%) were complete. One hundred and fifty-three (83.2%) participants use dexmedetomidine. Numerous off-label uses of dexmedetomidine were reported including use in the paediatric population (48.4%), as part of a general anaesthetic (54.9%) and as an adjuvant to local anaesthetics in regional (9.4%) and neuroaxial blocks (7.2%). Four participants (2.6%) use dexmedetomidine to decrease spinal shivering while 23.5% use dexmedetomidine to treat emergence delirium. Off-label routes of administration were also identified, namely intranasal (10.5%), intrathecally (5.2%), buccal (2%), intra-articular (1.3%) and subcutaneous (0.65%). Conclusion-This study has shown that dexmedetomidine is extensively used in adult and paediatric patients by anaesthetists in South Africa. It is also administered via other than the registered intravenous route. Results from this study may stimulate future research that could contribute to the expansion of dexmedetomidine registration.