Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery

Abstract

BackgroundPostoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery.Methods and ResultsA prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005).ConclusionProphylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.

Efficacy of dexmedetomidine in prevention of junctional ectopic tachycardia and acute kidney injury after pediatric cardiac surgery: A meta‐analysis

“…Dexmedetomidine is a highly selective α2 adrenoceptor agonist with sedative, analgesic, and anxiolytic properties and is widely used as a sedative and analgesic in the ICU. Currently, several small, single‐center randomized controlled trials (RCTs) reported that prophylactic dexmedetomidine is useful for the prevention of JET in pediatric cardiac surgery patients . Furthermore, the present research also suggested that the administration of dexmedetomidine might reduce the incidence of AKI after cardiac surgery with CPB .…”

Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery patients: A systematic review and meta‐analysis

“…Two additional secondary outcomes, inotrope scores and total mechanical ventilation time, were reported by 4 studies, which showed significant decreases in both outcomes (Figure B,C). Specifically, there was a decrease in the standard difference in mean of inotropic scores in the dexmedetomidine group by −0.562 (CI 95% −1.087;−0.017, P = .043), and a decrease in the standard difference in mean of total mechanical ventilation time in the dexmedetomidine group by −1.169 hours (CI 95% −2.012;−0.35, P = .007).…”

“…Of note, 6 studies reported choice of “placebo” administration in the control group, and they were variable (Table ). Three studies used normal saline infusion . In another study, fentanyl infusion was reported .…”

“…As shown in Figure A, perioperative dexmedetomidine infusion was associated with a significant reduction in total ICU stay (standard difference in mean, or MD = −1.545 days [CI 95% −2.686;−0.0405], P = .008). Furthermore, 2 studies reported total hospital days, showing a trend toward a decrease in total hospital days in the dexmedetomidine group, although it did not meet predetermined statistical significance (MD = −1.834 days [3.79;0.128], P = .067).…”

“…As bradycardia and hypotension are commonly described adverse effects of dexmedetomidine in the ICU settings, we performed further analyses to determine whether these events were increased in the dexmedetomidine group. A total of 4 studies reported bradycardic events and a total of 3 studies reported hypotensive events in their study subjects. As shown in Figure A, dexmedetomidine was associated with increased odds of bradycardia, although it was not statistically significant (OR = 1.127 [CI 95% 0.803;1.582], P = .490).…”