Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis

Wang, Qing; Chen, Chuikai; Wang, Li

doi:10.1016/j.jped.2021.05.008

Cited by 10 publications

(3 citation statements)

References 46 publications

(103 reference statements)

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“…Dosing of dexmedetomidine for continuous infusion can vary widely from doses of 0.2–1.5 mcg/kg/h 16,17 . At our institution, dexmedetomidine is often capped at 1 to 1.2 mcg/kg/h and this dose is rarely exceeded.…”

Section: Discussionmentioning

confidence: 99%

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A pilot study of ADRA2A genotype association with doses of dexmedetomidine for sedation in pediatric patients

et al. 2022

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Study Objective Dexmedetomidine is titrated to achieve sedation in the pediatric and cardiovascular intensive care units (PICU and CVICU). In adults, dexmedetomidine response has been associated with an ADRA2A polymorphism (rs1800544); CC genotype is associated with an increased sedative response compared with GC and GG. To date, this has not been studied in children. Design We conducted a pilot study to determine whether ADRA2A genotype is associated with dexmedetomidine dose in children. Measurements and Main Results Forty intubated PICU or CVICU patients who received dexmedetomidine as a continuous infusion for at least 2 days were genotyped for ADRA2A with a custom‐designed TaqMan® Assay. Ten (25%) subjects were wildtype (GG), 15 (37.5%) were heterozygous (GC), and 15 (37.5%) were homozygous (CC) variant. The maximum dexmedetomidine doses (mCg/kg/h) were not different between genotype groups CC (1, 0.3–1.2), GC (1, 0.3–1.3), and GG (0.8, 0.3–1.2), (p = 0.37); neither were mean dexmedetomidine doses for these respective genotype groups 0.68 (0.24–1.07), 0.72 (0.22–0.98), 0.58 (0.3–0.94), (p = 0.67). Conclusions These findings did not confirm the results from adult studies where ADRA2A polymorphisms correlate with dexmedetomidine response, therefore highlighting the need for pediatric studies to validate PGx findings in adults prior to implementation in pediatrics.

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Section: Discussionmentioning

confidence: 99%

“…widely from doses of 0.2-1.5 mcg/kg/h. 16,17 At our institution, dexmedetomidine is often capped at 1 to 1.2 mcg/kg/h and this dose is rarely exceeded. In instances where the maximum dexmedetomidine dose is received, other drugs are added to achieve desired sedation.…”

Section: Dosing Of Dexmedetomidine For Continuous Infusion Can Varymentioning

confidence: 99%

A pilot study of ADRA2A genotype association with doses of dexmedetomidine for sedation in pediatric patients

et al. 2022

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“…Dexmedetomidine is a potent, highly selective alpha-2 adrenoceptor agonist with sedative, analgesic, anxiolytic, anti-sympathetic and opioid-sparing properties [4,5].A number of studies have shown that dexmedetomidine is a useful adjunct to cardiac anesthesia [6,7] .Dexmedetomidine acts as an anesthetic adjuvant, reducing the need for opioids, inhalation anesthetics and intravenous anesthetics [8], and its anti-sympathetic activity reduces myocardial oxygen consumption by decreasing metabolism and preventing tachycardia, thereby reducing the incidence of postoperative complications in cardiac surgery, including myocardial ischemia [8,9] .Therefore, in addition to investigating the more de nitive endpoint of myocardial injury/infarction, this study examined the potential impact of dexmedetomidine on other primary endpoints, such as cardiac arrest during the postoperative period in patients undergoing cardiac surgery, congestive heart failure (CHF), and atrial brillation. Several studies have reported a reduction in cicu residence time with perioperative dexmedetomidine [10][11][12] ,suggesting that dexmedetomidine may promote rapid recovery of cardiac function in patients [12], but it is unknown whether the use of dexmedetomidine during maintenance of anesthesia for cardiac surgery has such an effect. Therefore, the speci c aim of this study was to assess whether the intraoperative use of dexmedetomidine as an anesthetic adjuvant was associated with a reduced CICU length of stay and a lower rate of major postoperative complications in patients undergoing heart valve surgery.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and CICU length of stay after heart valve surgery

Fan

Tang

Pan

et al. 2023

Preprint

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Background: We sought to explore the relationship between dexmedetomidine as an anesthetic adjuvant in cardiac surgery and postoperative complications and length of stay (LOS) in the cardiac intensive care unit (CICU). Methods: We conducted a retrospective study of patients aged 18 years and older who underwent heart valve surgery between October 2020 and June 2022. The study endpoints were a combination of adverse outcomes, which included major postoperative complications (cardiac arrest, atrial fibrillation, myocardial injury/infarction, heart failure) and prolonged CICU LOS (defined as LOS≥90th percentile). Multivariate logistic regression analysis was performed for variables that were significant in the univariate analysis. Results: A total of 856 patients entered our study. Of these, 283（33.06%） patients experienced at least one adverse outcome and the remaining 573 were included in the prognostic control group. Multivariate logistic regression analysis revealed that age > 60years (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.27–2.37; p=0.01), cardiopulmonary bypass( CPB)> 190min (OR, 1.58; 95% CI, 1.01-2.48; p = 0.04) and postoperative mechanical ventilation time > 10 h (OR, 2.03; 95% CI, 1.49-2.77; p < 0.01) were independent risk factors for major complications and prolonged CICU length of stay in patients undergoing heart valve surgery. Intraoperative use of dexmedetomidine as an anesthetic adjuvant was a protective factor for such patients (odds ratio, 0.53; 95% confidence interval, 0.37-0.78; p = 0.01). Conclusions: Age, duration of cardiopulmonary bypass, and duration of mechanical ventilation are associated with major complications and increased CICU stay after heart valve surgery. Intraoperative use of dexmedetomidine may improve such clinical outcomes.

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Using Real‐World Data to Externally Evaluate Population Pharmacokinetic Models of Dexmedetomidine in Children and Infants

McCann,

Helfer,

Balevic

et al. 2024

The Journal of Clinical Pharma

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Dexmedetomidine is a sedative used in both adults and off‐label in children with considerable reported pharmacokinetic (PK) interindividual variability affecting drug exposure across populations. Several published models describe the population PKs of dexmedetomidine in neonates, infants, children, and adolescents, though very few have been externally evaluated. A prospective PK dataset of dexmedetomidine plasma concentrations in children and young adults aged 0.01–19.9 years was collected as part of a multicenter opportunistic PK study. A PubMed search of studies reporting dexmedetomidine PK identified five population PK models developed with data from demographically similar children that were selected for external validation. A total of 168 plasma concentrations from 102 children were compared with both population (PRED) and individualized (IPRED) predicted values from each of the five published models by quantitative and visual analyses using NONMEM (v7.3) and R (v4.1.3). Mean percent prediction errors from observed values ranged from −1% to 120% for PRED, and −24% to 60% for IPRED. The model by James et al, which was developed using similar “real‐world” data, nearly met the generalizability criteria from IPRED predictions. Other models developed using clinical trial data may have been limited by inclusion/exclusion criteria and a less racially diverse population than this study's opportunistic dataset. The James model may represent a useful, but limited tool for model‐informed dosing of hospitalized children.

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Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis

Cited by 10 publications

References 46 publications

A pilot study of ADRA2A genotype association with doses of dexmedetomidine for sedation in pediatric patients

A pilot study of ADRA2A genotype association with doses of dexmedetomidine for sedation in pediatric patients

Dexmedetomidine as an anesthetic adjunct is associated with reduced complications and CICU length of stay after heart valve surgery

Using Real‐World Data to Externally Evaluate Population Pharmacokinetic Models of Dexmedetomidine in Children and Infants

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