The role of dexmedetomidine in fast-track extubation for closed congenital heart surgery in children: a randomized double-blinded placebo-controlled trial

A retrospective analysis of dexmedetomidine and morphine in the fast‐track and ultra‐fast‐track extubation protocol after congenital cardiac surgery

“…For this purpose, it is very crucial to select a proper sedative‐analgesic agent to maintain adequate sedation‐analgesia in the postoperative period. Opioids, particularly morphine, are the first choice in pain management after congenital cardiac surgery 3–6 . However, they have some disadvantages, particularly when they are used at high doses, such as prolonging MV support duration with their respiratory depressant effects 7–9 …”

“…Dexmedetomidine, a selective α2‐adrenoceptor agonist, has potential analgesic and sedative effects without respiratory depression by acting on α2 receptors in the locus coeruleus 5,8 . In many studies, it has been shown that dexmedetomidine can shorten the length of MV and stay in the ICU without significant respiratory distress and with lower analgesic requirements 8,9 .…”

“…Although FTE after congenital cardiac surgery was first described in the early 1970s and proved its potential benefits, it is still not a widely accepted and applicable method due to the complexity of congenital cardiac surgery operations, while it has been widely used for adult patients. [1][2][3][4][5][13][14][15][16][17][18][19] Postoperative early extubation and shorter MV support can enhance recovery after congenital cardiac surgery in selected patients. For this purpose, it is very crucial to select a proper sedative-analgesic agent to maintain adequate sedation-analgesia in the postoperative period.…”

“…Opioids, particularly morphine, are the first choice in pain management after congenital cardiac surgery. [3][4][5][6] However, they have some disadvantages, particularly when they are used at high doses, such as prolonging MV support duration with their respiratory depressant effects. [7][8][9] Dexmedetomidine, a selective α2-adrenoceptor agonist, has potential analgesic and sedative effects without respiratory depression by acting on α2 receptors in the locus coeruleus.…”

“…[1][2][3][4] Potential advantages of FTE protocols following surgery for congenital cardiac disease are reduced ventilator-associated pulmonary complications and the negative effects of positive pressure ventilation, reduced nosocomial infections, postoperative atelectasis, reduced requirements of sedatives and analgesic drugs, early enteral feeding, rapid patient mobilization, and shorter intensive care unit (ICU) stay. [5][6][7] To prevent these potential adverse effects, short-acting analgesic-sedative agents are preferred for pain management and sedation to achieve an FTE-UFTE protocol after congenital cardiac surgery. [7][8][9] Opioids, particularly morphine, are the most frequently used analgesic-sedative agents after congenital cardiac surgery to achieve FTE protocol.…”