Dexmedetomidine improves the outcomes in paediatric cardiac surgery: a meta-analysis of randomized controlled trials

Abstract

Perioperative administration of dexmedetomidine to paediatric patients undergoing cardiac surgery may shorten the duration of mechanical ventilation, LOS in the intensive care unit and in the hospital and reduce the incidence of junctional ectopic tachycardia. More high-quality randomized controlled trials are encouraged to verify the beneficial effect of dexmedetomidine before its clinical application in paediatric patients undergoing surgery for congenital heart disease.

A retrospective analysis of dexmedetomidine and morphine in the fast‐track and ultra‐fast‐track extubation protocol after congenital cardiac surgery

“…A meta‐analysis performed by Liu et al 9 including nine trials with a total of 837 pediatric patients undergoing cardiac surgery revealed that the perioperative administration of dexmedetomidine shortened the MV duration in the ICU setting. In addition, dexmedetomidine reduced the risk of the incidence of JET in these patients.…”

“…8,9 Besides these effects, dexmedetomidine can decrease arrhythmias (atrial fibrillation), postoperative ventricular and supraventricular tachyarrhythmias. 8,9 Bradycardia is the most common cardiovascular side effect during the use of dexmedetomidine, which particularly occurs with the utilization of bolus doses. [7][8][9] For the last 3 years, we have used these two agents for FTE and UFTE after congenital cardiac surgery.…”

“…Since it has relatively few cardiovascular side effects and produces sleep‐like sedation without narcosis or respiratory depression, it has been started to be used frequently for postoperative sedation‐analgesia after congenital cardiac surgery 8,9 . Besides these effects, dexmedetomidine can decrease arrhythmias (atrial fibrillation), postoperative ventricular and supraventricular tachyarrhythmias 8,9 . Bradycardia is the most common cardiovascular side effect during the use of dexmedetomidine, which particularly occurs with the utilization of bolus doses 7–9 …”

“…Potential advantages of FTE protocols following surgery for congenital cardiac disease are reduced ventilator‐associated pulmonary complications and the negative effects of positive pressure ventilation, reduced nosocomial infections, postoperative atelectasis, reduced requirements of sedatives and analgesic drugs, early enteral feeding, rapid patient mobilization, and shorter intensive care unit (ICU) stay 5–7 . To prevent these potential adverse effects, short‐acting analgesic‐sedative agents are preferred for pain management and sedation to achieve an FTE‐UFTE protocol after congenital cardiac surgery 7–9 …”

The evolving role of dexmedetomidine in pediatric cardiac surgery: Beyond anxiolysis

“…This study included 9 trials and 837 patients; DEX use was associated with shorter ICU-LOS, shorter ventilation time, and less JET. 19 Amula et al reviewed 322 infants having surgical repair of TOF or coarctation between 2013 and 2015. After implementation of an early extubation protocol, the likelihood of UFTE was nearly twice as likely if DEX was used.…”