Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery

Shepard, Suzanne; Tejman‐Yarden, Shai; Khanna, Sandeep; Davis, Christopher K.; Batra, Anjan S.

doi:10.1097/ccm.0b013e3181feb4b3

Cited by 22 publications

(18 citation statements)

References 17 publications

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“…12 Although bradyarrhythmias associated with dexmedetomidine have generally been mild, there have been previous case reports of serious bradyarrhythmias, such as sudden pauses, sinus arrest and loss of pacemaker capture occurring after dexmedetomidine administration. 10, 17–19 These findings would suggest caution when administering dexmedetomidine in patients with predisposing conduction abnormalities and in those who are pacemaker dependent.…”

Section: Discussionmentioning

confidence: 97%

Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Shuplock

Smith

Owen

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Background Dexmedetomidine is commonly used after congenital heart surgery and may be associated with a decreased incidence of post-operative tachyarrhythmias. Using a large cohort of patients undergoing congenital heart surgery, we examined for an association between dexmedetomidine use in the immediate post-operative period and subsequent arrhythmia development. Methods and Results A total of 1,593 surgical procedures for congenital heart disease were performed. Dexmedetomidine was administered in the immediate post-operative period after 468 (29%) surgical procedures. Compared to 1,125 controls, the group receiving dexmedetomidine demonstrated significantly fewer tachyarrhythmias (29% vs. 38%, p<0.001), tachyarrhythmias receiving intervention (14% vs. 23%, p<0.001), bradyarrhythmias (18% vs. 22%, p=0.03) and bradyarrhythmias receiving intervention (12% vs. 16%, p=0.04). After propensity score matching with 468 controls, the arrhythmia incidence between groups became similar: tachyarrhythmias (29% vs. 31%, p=0.66), tachyarrhythmias receiving intervention (14% vs. 17%, p=0.16), bradyarrhythmias (18% vs. 15%, p=0.44) and bradyarrhythmias receiving intervention (12% vs. 9%, p=0.17). After excluding controls exposed to dexmedetomidine at a later time in the hospitalization, dexmedetomidine was associated with increased odds of bradyarrhythmias receiving intervention (odds ratio [OR] 2.18, 95% confidence interval (CI) 1.02 – 4.65). Furthermore, there was a dose-dependent increase in the odds of bradyarrhythmias (OR 1.04, 95% CI 1.01 – 1.07) and bradyarrhythmias receiving intervention (OR 1.05, 95% CI 1.01 – 1.08). Conclusions While dexmedetomidine exposure in the immediate post-operative period is not associated with a clinically meaningful difference in the incidence of tachyarrhythmias after congenital heart surgery, it may be associated with increased odds of bradyarrhythmias.

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Section: Discussionmentioning

confidence: 97%

Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Shuplock

Smith

Owen

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…[2–42122] Caution should be exercised in patients who are volume depleted, vasoconstricted, or have severe heart block. [2421] Publication of few cases of asystole after its use warrants intense vigilance with its use and the need for a large-scale study on its safety. [2324]…”

Section: Intensive Care Sedationmentioning

confidence: 99%

Dexmedetomidine: New avenues

Grewal

2011

J Anaesthesiol Clin Pharmacol

192

161

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“…Adverse events that commonly occur with dexmedetomidine include bradycardia and hypotension, but these were unable to be reliably evaluated in using an administrative database. [17][18][19][20][21][22] Future investigations into the utility of dexmedetomidine in critically ill postoperative cardiac surgical patients should account for the severity of illness beyond age and surgical complexity.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine utilisation and outcomes of children with trisomy 21 undergoing congenital heart disease surgery

et al. 2014

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Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery

Abstract: As a result of these findings, caution is warranted in the administration of DEX to patients with predisposing conduction abnormalities and patients who are pacemaker-dependent.

Cited by 22 publications

References 17 publications

Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Association Between Perioperative Dexmedetomidine and Arrhythmias After Surgery for Congenital Heart Disease

Dexmedetomidine: New avenues

Dexmedetomidine utilisation and outcomes of children with trisomy 21 undergoing congenital heart disease surgery

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