Comparison of the Effects of Dexmedetomidine and Propofol on Hemodynamics and Oxygen Balance in Children with Complex Congenital Heart Disease Undergoing Cardiac Surgery

Cheng, Xinqi; Zuo, You-Mei; Zhao, Quanming; Gu, Erwei; Huang, Yue

doi:10.1111/chd.12228

Cited by 12 publications

(18 citation statements)

References 22 publications

(39 reference statements)

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“…Of the remaining 28 eligible studies, 14 were removed because they reported on other outcomes, they were not full-text, or two publications used the same patients. Fourteen studies were included in the final meta-analysis (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The selection process is detailed in Figure 1.…”

Section: Literature Search and Study Selectionmentioning

confidence: 99%

“…All of the studies were published from 2006 to 2015; the sample sizes ranged from 14 to 1088, and the total number of patients was 2229 (dexmedeto-midine group, n = 1055; control group, n = 1174). Five of the included studies were RCTs (20)(21)(22)(23)(24), one was a post hoc analysis of RCTs (25), and the remaining eight were cohort studies (26)(27)(28)(29)(30)(31)(32)(33): four retrospective (26,29,30,33) and four prospective (27,28,31,32).…”

Section: Article Characteristicsmentioning

confidence: 99%

“…Mean blood pressure (MBP) was investigated in five studies (356 children) (20,21,27,28,33), and systolic blood pressure (SBP) was investigated in five studies (227 children) (22)(23)(24)27,31). Heart rate data were presented in nine studies (526 children) (20)(21)(22)(23)(24)27,28,31,33). All of the hemodynamic values were obtained at the point of skin incision or sternotomy, when the maximal increase in heart rate and blood pressure occurred.…”

Section: Effects On Hemodynamicsmentioning

confidence: 99%

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Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta‐analysis

Pan

Wang

Lin

et al. 2015

Pediatric Anesthesia

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What is already known • Dexmedetomidine is a safe and efficacious sedative agent, and can offer some benefit for adult patients undergoing cardiac surgery. What this article adds • Perioperative dexmedetomidine treatment improves the outcomes in children undergoing congenital heart disease surgery, including more stable hemodynamics, shorter ventilation duration, and lesser incidence of postop-erative agitation, and rescue analgesia. Summary Background: Dexmedetomidine decreases cardiac complications in adults undergoing cardiovascular surgery. This systematic review assessed whether perioperative dexmedetomidine improves congenital heart disease (CHD) surgery outcomes in children. Methods: The PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) or observational studies that were published until 16 April 2015 and compared dexmedetomidine with placebo or an alternative anesthetic agent during pediatric CHD surgery. The assessed outcomes included hemodynamics, ventilation length, intensive care unit (ICU) and hospital stays, blood glucose and serum cortisol levels, post-operative analgesia requirements, and postoperative delirium. Results: Five RCTs and nine observational studies involving 2229 patients were included. In pooled analyses, dexmedetomidine was associated with shorter length of mechanical ventilation (mean difference: À93.36, 95% CI: À137.45, À49.27), lower postoperative fentanyl (mean difference: À24.11, 95% CI: À36.98, À11.24) and morphine (mean difference: À0.07, 95% CI: À0.14, 0.00) requirements, reduced stress response (i.e., lower blood glucose and serum cortisol levels), and lower risk of delirium (OR: 0.39, 95% CI: 0.21, 0.74). The hemodynamics of dexmedetomidine-treated patients appeared more stable, but there were no significant differences in the ICU or hospital stay durations. Dexmedetomidine may increase the bradycardia and hypotension risk (OR: 3.14, 95% CI: 1.47, 6.69). Conclusions: Current evidence indicates that dexmedetomidine improves outcomes in children undergoing CHD surgery. However, this finding largely relies on data from observational studies; high-quality RCTs are warranted because of the potential for subject selection bias.

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Section: Literature Search and Study Selectionmentioning

confidence: 99%

Section: Article Characteristicsmentioning

confidence: 99%

Section: Effects On Hemodynamicsmentioning

confidence: 99%

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Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta‐analysis

Pan

Wang

Lin

et al. 2015

Pediatric Anesthesia

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“…In recent years, with the development of anesthesia and cardiopulmonary bypass technology, incidence of postoperative cognitive dysfunction was significantly decreased, but still cannot be eradicated ( 4 ). Dexmedetomidine, as a new and efficient adrenergic receptor agonist α2, can induce physiological sleep ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting

Gong

Zhong

et al. 2018

Exp Ther Med

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Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting were investigated. Eighty patients undergoing systemic anesthesia with extracorporeal coronary artery bypass grafting in The People's Hospital of Guangxi Zhuang Autonomous Region from January 2015 to August 2017 were selected and randomly divided into the observation group (n=40) and control group (n=40). The two groups were treated with dexmedetomidine and equal volume of normal saline, respectively. Moreover, safety indexes including EEG bispectral index (BIS) at 30 min before induction of anesthesia (T0), immediately after intubation (T1), when incision was made (T2), when chest was closed (T3), when operation was completed (T4) and at 6 h after operation (T5), intraoperative circulatory system-related complications, cortisol, epinephrine and norepinephrine levels at the end of surgery as well as anesthesia recovery time and postoperative mechanical ventilation time were recorded and compared. All the patients were followed up for 1 week. Mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) were administered at 1, 3 and 7 days after operation, and the incidence of intraoperative awareness and postoperative cognitive dysfunction was recorded. BIS value in the observation group was lower than that in the control group (P<0.05) at T1-T4 time points, and the BIS value in the observation group was higher than that in the control group (P<0.05) at T5. Incidence rates of intraoperative arrhythmia, hypertension and hypotension in the observation group was significantly lower than those in the control group (P<0.05). At the end of operation, levels of cortisol, epinephrine and norepinephrine in the observation group were significantly lower than those in the control group (P<0.05). Anesthesia recovery time and postoperative mechanical ventilation time in the observation group was significantly shorter than the time in the control group (P<0.05). MMSE and MoCA scores of the observation group were better than those of the control group (P<0.05). The incidence of cognitive impairment and postoperative cognitive impairment in the observation group was significantly lower than those in the control group (P<0.05). Therefore, it is concluded that dexmedetomidine can effectively reduce the incidence of postoperative cognitive impairment in patients undergoing coronary artery bypass grafting, and it is of high safety for circulatory function.

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“…Even when initiated after CBP infusion of dexmedetomidine was associated with decreased postoperative mortality up to 1 year and decreased incidence of postoperative complications and delirium in patients undergoing cardiac surgery [ 17 ] . In children undergoing complex congenital heart disease the use of dexmedetomidine after anesthesia induction was associated with less variability in heart rate and blood pressure than with the use of propofol [ 18 ] .…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine as an anesthetic adjuvant in cardiac surgery: A cohort study

Brandão¹,

Lobo²,

Ramin³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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OBJECTIVE:α-2-agonists cause sympathetic inhibition combined with parasympathetic activation and have other properties that could be beneficial during cardiac anesthesia. We evaluated the effects of dexmedetomidine as an anesthetic adjuvant compared to a control group during cardiac surgery.METHODS:We performed a retrospective analysis of prospectively collected data from all adult patients (> 18 years old) undergoing cardiac surgery. Patients were divided into two groups, regarding the use of dexmedetomidine as an adjuvant intraoperatively (DEX group) and a control group who did not receive α-2-agonist (CON group).RESULTS:A total of 1302 patients who underwent cardiac surgery, either coronary artery bypass graft or valve surgery, were included; 796 in the DEX group and 506 in the CON group. Need for reoperation (2% vs. 2.8%, P=0.001), type 1 neurological injury (2% vs. 4.7%, P=0.005) and prolonged hospitalization (3.1% vs. 7.3%, P=0.001) were significantly less frequent in the DEX group than in the CON group. Thirty-day mortality rates were 3.4% in the DEX group and 9.7% in the CON group (P<0.001). Using multivariable Cox regression analysis with in hospital death as the dependent variable, dexmedetomidine was independently associated with a lower risk of 30-day mortality (odds ratio [OR]=0.39, 95% confidence interval [CI]: 0.24-0.65, P≤0.001). The Logistic EuroSCORE (OR=1.05, 95% CI: 1.02-1.10, P=0.004) and age (OR=1.03, 95% CI: 1.01-1.06, P=0.003) were independently associated with a higher risk of 30-day mortality.CONCLUSION:Dexmedetomidine used as an anesthetic adjuvant was associated with better outcomes in patients undergoing coronary artery bypass graft and valve surgery. Randomized prospective controlled trials are warranted to confirm our results.

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Comparison of the Effects of Dexmedetomidine and Propofol on Hemodynamics and Oxygen Balance in Children with Complex Congenital Heart Disease Undergoing Cardiac Surgery

Cited by 12 publications

References 22 publications

Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta‐analysis

Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta‐analysis

Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting

Dexmedetomidine as an anesthetic adjuvant in cardiac surgery: A cohort study

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