The effect of intraoperative dexmedetomidine on acute kidney injury after pediatric congenital heart surgery

Abstract

Background:Dexmedetomidine has been reported to have a renal protective effect after adult open heart surgery. The authors hypothesized that intraoperative infusion of dexmedetomidine would attenuate the decrease in renal function after pediatric open heart surgery.Methods:Twenty-nine pediatric patients (1–6 years) scheduled for atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n = 14) or dexmedetomidine (a bolus dose of 0.5 μg/kg and then an infusion of 0.5 μg/kg/h) (dexmedetomidine group, n = 15) from anesthesia induction to the end of cardiopulmonary bypass. Serum creatinine (Scr) was measured before surgery (T0), 10 minutes after anesthesia induction (T1), 5 minutes after cardiopulmonary bypass weaning (T2), 2 hours after T2 (T3), and after postoperative day 1 (POD1) and postoperative day 2 (POD2) and estimated glomerular filtration rates (eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3. Acute kidney injury (AKI) was defined as an absolute increase in Scr of ≥ 0.3 mg/dL or a percent increase in Scr of ≥50%.Results:The incidence of AKI during the perioperative period was significantly higher in the control group than in the dexmedetomidine group (64% [9/14] vs 27% [4/15], P = .042). eGFR was significantly lower in the control group than in the dexmedetomidine group at T2 (72.6 ± 15.1 vs 83.9 ± 13.5, P = .044) and T3 (73.4 ± 15.4 vs 86.7 ± 15.9, P = .03).Conclusion:Intraoperative infusion of dexmedetomidine may reduce the incidence of AKI and suppress post-bypass eGFR decline.

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

“…Five studies were excluded for several reasons including the lack of primary outcomes, evaluation of noncardiac surgery, and the lack of a control group. Eventually, 9 studies comprising 4 RCTs, 1 quasi‐RCT and 4 observational cohort studies ultimately met our selection criteria and were included in the quantitative synthesis. Among them, 7 studies were pooled for JET, and 2 studies were pooled for AKI .…”

“…Based on our literature review, there are two studies including 1RCT and 1 retrospective study that have assessed the efficacy of dexmedetomidine in the prevention of pediatric cardiac surgery associated AKI . Positive renoprotective effects were reported in these two studies.…”

“…Among them, 7 studies were pooled for JET, [13][14][15][16]21,22,24 and 2 studies were pooled for AKI. 20,23 A flow diagram for the meta-analysis is presented in Sensitivity analysis excluding each included study one by one did not significantly alter the effect estimate of JET and mortality.…”

The sympathetic nervous system in acute kidney injury

“…62 Prospective studies in cardiac surgery are sparse and rather small. 65 Together, available data on the efficacy of sympatholytic drugs added peri-operatively to the patients' medications in clinical scenarios where renal ischaemia and sympathetic activation likely contribute to AKI are ambiguous. 64 A single-centre study in 30 paediatric patients (1-6 years old) who underwent cardiac surgery reported lower GFR and higher AKI incidence based on serum creatinine measurements obtained 5 minutes and 2 hours after weaning from cardiopulmonary bypass.…”

“…64 A single-centre study in 30 paediatric patients (1-6 years old) who underwent cardiac surgery reported lower GFR and higher AKI incidence based on serum creatinine measurements obtained 5 minutes and 2 hours after weaning from cardiopulmonary bypass. 65 Together, available data on the efficacy of sympatholytic drugs added peri-operatively to the patients' medications in clinical scenarios where renal ischaemia and sympathetic activation likely contribute to AKI are ambiguous. In contrast to experimental renal IR studies where conditions can be well standardized, the effects of sympatholytics may have been blurred by the complexity of clinical scenarios and factors such as patient age, genetic diversity, associated chronic diseases and diverse co-medications.…”