Hemodynamic Effects of the Combination of Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Klamt, Jyrson Guilherme; Vicente, Walter Villela de Andrade; Garcia, Luís Vicente; Ferreira, César Augusto

doi:10.1016/s0034-7094(10)70044-1

Cited by 16 publications

(18 citation statements)

References 25 publications

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“…[21] We showed that infusion of Dex without fentanyl stabilizes hemodynamics during CPB pump and postoperative. It is important to note that in our study, Dex was infused at lower dose 0.5 μg/kg/h compared to 1 μg/kg/h in Klamt study.…”

Section: Discussionmentioning

confidence: 99%

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

et al. 2017

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Objective:To determine the effect of dexmedetomidine (Dex) on hemodynamic changes during cardiopulmonary pump and postoperative period in coronary artery bypass grafting (CABG).Methods and Design:This study is designed as a double-blinded, randomized clinical trial.Setting:University hospital and single center.Participants:patients candidate for elective CABG.Intervention:Dex 0.5 μg/kg/h or placebo was infused from the initiation of anesthesia up to extubation in Intensive Care Unit (ICU).Measurements:Heart rate (HR) and blood pressure (BP), pain score, and total morphine dose requirement were monitored and compared during cardiac pump up to 12 h postoperative in ICU.Results:Mean arterial pressure was significantly higher in Dex group in postoperation period at 1 (P = 0.010) and 2 h (P = 0.002) compared to control group. HR was significantly lower in Dex group in postcardiopulmonary bypass (CPB) time at 0 h (P = 0.001), 1 h (P = 0.0016), and 2 h (P = 0.001), and then in postoperative period in ICU at 1 h (P = 0.025), 2 h (P = 0.0012), and 4 h (P = 0.0025) compared to control group. Postoperative pain score was significantly lower during 12 h after surgery.Conclusion:Dex could effectively blunt hemodynamic response to surgical stress, particularly during CPB pump and afterward. Infusion of Dex maintains BP at higher range and HR at lower range compared to placebo.

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Section: Discussionmentioning

confidence: 99%

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

et al. 2017

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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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“…We hypothesized that dexmedetomidine might be an effective substitute for propofol in pediatric anesthesia, based on the capacities of dexmedetomidine to provide effective surgical sedation and to reduce sympathetic tone, thereby buffering the hemodynamic response to surgical stress and maintaining the oxygen delivery/ consumption balance. 7 The aim of this study was to compare the effects of dexmedetomidine and propofol anesthesia on the hemodynamics and oxygen balance in children with complex CHD who were undergoing CPB.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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Hemodynamic Effects of the Combination of Dexmedetomidine-Fentanyl versus Midazolam-Fentanyl in Children Undergoing Cardiac Surgery with Cardiopulmonary Bypass

Abstract: Infusion of dexmedetomidine without bolus seems to be an effective adjuvant to fentanyl on the promotion of sedation and control of hemodynamic responses during surgery for congenital cardiopathies in children.

Cited by 16 publications

References 25 publications

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting

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

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

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