Supraventricular tachycardia after withdrawal of prolonged dexmedetomidine infusion in a paediatric patient without heart disease

Flores-González, José Carlos; Estalella-Mendoza, Ana; Hernández-Gonzalez, Arturo; Rubio-Quiñones, Fernando; Rodríguez-Campoy, Patricia; Saldaña-Valderas, Mónica

doi:10.1111/jcpt.12564

Cited by 5 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Because it can potentially have an adverse impact on patients with underlying heart disease, and thus may cause left ventricular dysfunction and hemodynamic instability [32]. Flores-González et al [33] reported that the infusion duration of DEXm for 10 days and cessation it for 12 hours resulted in 4-year-old girl occurrence of a paroxysmal SVTs.…”

Section: Discussionmentioning

confidence: 99%

Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

Xu¹,

Hu²,

Guo³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Supraventricular tachycardias (SVTs) can increase the risk of adverse events in perioperative period. Previous studies have shown that application of dexmedetomidine (DEXm) combined anesthesia during surgery can significantly reduce postoperative cardiovascular and cerebrovascular complications and mortality in patients with cardiac disease. In fact, many anesthetic drugs have cardiac protection effects. However, it is a pity that these findings are not well applied in clinical practice to treat cardiac disease. Therefore, the aim of this study was to explore the therapeutic effect of DEXm on perioperative SVTs in adult patients with non-cardiac surgery. Methods: Forty-two patients with SVTs, aged between 35 and 61 years, were randomly divided into DEXm group (group D) and midazolam group (group M). The patients undergoing elective surgery in two groups were infused intravenously DEXm 0.5-1µg/kg or midazolam 0.06-0.08mg/kg using a micro-pump for 10 minutes, respectively. The the Observer’s Assessment of Alertness/Sedation (OAA/S) score, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and occurrence of SVTs, heart rate variability (HRV) including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and the balance ratio of sympathetic to vagal tone (LF/HF) in two groups were recorded at T0 (before the infusion DEXm or midazolam), T1 (5 minutes after the infusion), T2 (at the end of the infusion), T3 (5 minutes after the end of the infusion), and T4 (10 minutes after the end of the infusion). Results: The OAA/S score in two groups at T4 was obviously decreased compared with T0. And the OAA/S score in group M was lower than in group D at T4 (P<0.05). Compared to T0, HR and MAP in two groups were obviously decreased, and HR and MAP in group D were apparently lower than group M from T1 to T4 (P<0.05). Three patients developed mild hypotension in group D. However, none of patients developed clinically significant bradycardia, hypotension, and anoxia. There was no significant difference for SpO2 from T0 to T4 in group D. Compared to T0 or group D, SpO2 in group M obviously decreased at T2 (P<0.05). In addition, SVTs in all patients were terminated until T4 in group D after DEXm infusion. However, only two patients were finally improved in group M. Compared to T0, HFnorm were elevated, and LFnorm and LF/HF were decreased from T1 to T4, furthermore, the changes in HFnorm, LFnorm and LF/HF had statistical significance (P<0.05) in group D. However, there was no significant difference for HFnorm, LFnorm and LF/HF in group M from T0 to T4.Conclusions: Perioperative use of dexmedetomidine had a significant therapeutic effect for supraventricular tachycardias without significant adverse effects in adult patients .Trial Registration: ClinicalTrials.gov Registration Number: NCT04284150 on 26th February 2020

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

Xu¹,

Hu²,

Guo³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…A metanalysis of seven randomized controlled trials representing 1616 patients reported a significant reduction in JET, ICU stay, and duration of mechanical ventilation in those who received DEX [128]. Caution should be considered in the long-term use of DEX infusions, as there is a case report which describes supraventricular tachycardia during DEX weaning of a 4-year-old without pre-existing cardiac disease [129].…”

Section: Pediatric Intensive Care Unitmentioning

confidence: 99%

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Mahmoud

Barbi

Mason

2020

JCM

View full text Add to dashboard Cite

Over the past few years, despite the lack of approved pediatric labelling, dexmedetomidine’s (DEX) use has become more prevalent in pediatric clinical practice as well as in research trials. Its respiratory-sparing effects and bioavailability by various routes are only some of the valued features of DEX. In recent years the potential organ-protective effects of DEX, with the possibility for preserving neurocognitive function, has put it in the forefront of clinical and bench research. This comprehensive review focused on the pediatric literature but presents relevant, supporting adult and animal studies in order to detail the recent growing body of literature around the pharmacology, end-organ effects, organ-protective effects, alternative routes of administration, synergetic effects, and clinical applications, with considerations for the future.

show abstract

“…It is reported that large doses or rapid infusion of Dex can potentially have an adverse impact on patients with underlying heart disease, which may cause left ventricular dysfunction and hemodynamic instability [32]. Flores-González et al [33] reported that cessation of Dex for 12 hours after continuously infusing it for 10 days resulted in occurrence of paroxysmal SVT for a 4-years-old girl. However, our observation period was the time when patients was in the operating room, and we might have missed arrhythmias that occurred afterwards.…”

Section: Limitationsmentioning

confidence: 99%

Treatment of Supraventricular Tachycardia in Patients with Non-Cardiac Surgery by Dexmedetomidine During the Perioperative Period. A Randomized Trial

Xu¹,

X²,

Yang³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Previous studies have shown that application of dexmedetomidine (Dex) combined anesthesia during surgery can significantly reduce cardiovascular system complications and mortality of patients with cardiac disease during the perioperative period. The aim of this study was to explore the therapeutic effect of Dex on perioperative supraventricular tachycardia (SVT) in adult patients with non-cardiac surgery.Methods: Forty-six patients with SVT undergoing elective non-cardiac surgery were randomly divided into two groups, intravenously infused Dex (Dex group, 1.0 µg/kg) or midazolam (midazolam group, 0.06 mg/kg) for 10 minutes, respectively. The observation indexes containing the treatment efficiency of SVT, heart rate (HR) and and heart rate variability (HRV) including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and LFnorm/HFnorm were recorded.Results: Treatment rates of SVT were 21/23 (91.3%) in Dex group vs 2/23 (8.7%) in midazolam group (P<0.001). In Dex group, LFnorm and LFnorm/HFnorm were decreased, and HFnorm were elevated and HR were decreased after twenty-three patients infused Dex (P < 0.05). However, there was no difference for HFnorm, LFnorm and LFnorm/HFnorm in midazolam group (P > 0.05). Conclusion: Perioperative use of dexmedetomidine has a significant therapeutic effect for SVT, and its mechanism is related to adjust cardiac autonomic nervous system and has no obvious connection with sedation.Trial registration: This trial was registered at ClinicalTrials.gov. registry number: NCT04284150 on February 13, 2020.

show abstract

Supraventricular tachycardia after withdrawal of prolonged dexmedetomidine infusion in a paediatric patient without heart disease

Abstract: This is the first report of PSVT as an adverse reaction to DEX in a paediatric patient without heart disease.

Cited by 5 publications

References 8 publications

Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Treatment of Supraventricular Tachycardia in Patients with Non-Cardiac Surgery by Dexmedetomidine During the Perioperative Period. A Randomized Trial

Contact Info

Product

Resources

About

Supraventricular tachycardia after withdrawal of prolonged dexmedetomidine infusion in a paediatric patient without heart disease

Abstract: This is the first report of PSVT as an adverse reaction to DEX in a paediatric patient without heart disease.

Cited by 5 publications

References 8 publications

Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Treatment of Supraventricular Tachycardia in Patients with Non-Cardiac&nbsp;Surgery&nbsp;by Dexmedetomidine During the Perioperative&nbsp;Period. A Randomized Trial

Contact Info

Product

Resources

About

Treatment of Supraventricular Tachycardia in Patients with Non-Cardiac Surgery by Dexmedetomidine During the Perioperative Period. A Randomized Trial