Dexmedetomidine Attenuates Hypoxemia During Palliative Reconstruction of the Right Ventricular Outflow Tract in Pediatric Patients

Chen, Qiang; Wu, Wei; Zhang, Gui-Can; Cao, Hua; Hu, Yunnan; Chen, Yandan

doi:10.1097/md.0000000000000069

Cited by 7 publications

(11 citation statements)

References 27 publications

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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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“…This may be attributed to decreased HR induced lower oxygen consumption. Animal experiments have reported dexmedetomidine preconditioning exerts cardioprotective effects against hypoxia injury and can improve perioperative hypoxemia 18,19 .…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine Versus Midazolam on Cough and Recovery Quality After Partial and Total Laryngectomy – a Randomized Controlled Trial

Zhu²,

Lü

et al. 2020

Preprint

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Backgroundː During emergence from anesthesia after partial and total laryngectomy, excessive airway reflex and systemic hypertension may lead to pneumoderm, hemorrhage or pneumothorax. Methodsː ASA Ⅲ-Ⅳ male adults undergoing elective laryngectomy were recruited and randomly allocated to receive either dexmedetomidine or midazolam. The primary outcome was incidence and severity of cough. Pulse oximetry (SpO2 ), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Visual Analogue Scale (VAS) and Ramsay sedation scale (RSS) were recorded at the point of awareness and departure from PACU. Rescue analgesia required consumption, time of spontaneous breath recovery, duration of the PACU stay, incidence of adverse effects were also recorded.Resultsː The prevalence of no coughing was significantly higher in group D than group M while the patients were at the point of awake and departure. Compared with group M, there was significant decrease in HR, SBP and DBP in group D than group M, and SpO2 was statistically significantly higher in group D than group M at the moment of laryngectomy. Pain scores were lower in group D than group M. The Ramsay score at awake in PACU was higher in group D than group M. There was no difference in time to spontaneous breathing recovery, duration of the PACU stayand incidence of adverse effects.Conclusionsː Compared with midazolam, dexmedetomidine is an effective alternative to attenuate coughing and hemodynamic changes with low incidence of adverse events during emergence for partial and total laryngectomy.Trial registration: NCT03918889, registered at clinicaltrials.gov, date of registration: March 28, 2019. Https://register.clinicaltrials.gov/prs/app/action/DownloadReceipt?uid=U0003V5T&ts=3&sid=S0008S19&cx=haixch

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“…The hemodynamic characteristics of cyanotic congenital heart disease are pulmonary blood flow decreased (Sharkey and Sharma, 2012) while pathological examinations revealed small pulmonary artery hypoplasia in these patients due to a prolonged low blood flow (Chen et al, 2014). Hypoxemia is a serious complication that can easily develop after a cardiac operation.…”

Section: Introductionmentioning

confidence: 99%

Sildenafil in the Treatment of Postoperative Hypoxemia with High Resistance in Cyanotic Congenital Heart Disease

Jiawang

et al. 2017

American Journal of Biochemistry and Biotechnology

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This study was designed to determine the effect of sildenafil treatment on postoperative hypoxemia with high resistance in cyanotic congenital heart disease. A total of 247 cases of cyanotic congenital heart disease were operated on from May 2006 to August 2014. Only 45 cases exhibited postoperative hypoxemia after symptomatic treatment. Sildenafil at doses of 0.30-5 mg/kg every 6 h was administered in 24 cases while the other 21 were administered a placebo (the control group). The partial pressure of oxygen in arterial blood (PaO 2 ), systolic blood pressure, pulmonary arterial pressure and positive inotropic drugs score were evaluated at four time points including before (T1), 1 h (T2) and 1 day (T3) after treatment and when the ventilator was disconnected (T4). Furthermore, we compared the mechanical ventilation time between the two groups. Finally, there was one death in the placebo group while the others were cured. Compared with the placebo group, in the sildenafil group, the PaO 2 rebounded faster and the pulmonary arterial pressure decreased significantly; furthermore, there were statistically significant differences from time point T2 between both groups (p<0.001). The systolic blood pressure rose slowly and there were statistically significant differences between both groups from time point T3 (p<0.001). The representations of the positive inotropic drug scores were obviously different between the two groups. The sildenafil group scores decreased soon and maintained this trend. The placebo group scores initially increased and then began to decline 1 day after treatment, but the final score was higher than that of the sildenafil group. Compared with the placebo group, in the sildenafil group, the respiratory and heart functions recovered rapidly and the patient's stay on the mechanical ventilation was shorter (67.52±16.88 Vs. 44.25±13.39 h, p = 0.001). Therefore, sildenafil reduced pulmonary vascular resistance and obviously corrected the postoperative hypoxemia in cyanotic congenital heart disease.

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Dexmedetomidine Attenuates Hypoxemia During Palliative Reconstruction of the Right Ventricular Outflow Tract in Pediatric Patients

Cited by 7 publications

References 27 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

Dexmedetomidine Versus Midazolam on Cough and Recovery Quality After Partial and Total Laryngectomy – a Randomized Controlled Trial

Sildenafil in the Treatment of Postoperative Hypoxemia with High Resistance in Cyanotic Congenital Heart Disease

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