Treatment of Persistent Tachycardia with Dexmedetomidine During Off-Pump Cardiac Surgery

Ruesch, Sibylle; Levy, Jerrold H.

doi:10.1097/00000539-200208000-00012

Cited by 12 publications

(7 citation statements)

References 6 publications

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“…These results indicated that dexmedetomidine may be applied in the treatment of acute supraventricular tachycardia during the surgery of patients with congenital heart disease. Furthermore, Ruesch and Levy (19) revealed a case where sustained tachycardia during OPCAB surgery was successfully treated using dexmedetomidine. However, the effects of dexmedetomidine as an anti-arrhythmic drug have rarely been investigated in clinical studies.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Ren

Zhang

Huang

et al. 2013

Experimental and Therapeutic Medicine

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The aim of this study was to observe the impact of dexmedetomidine on postoperative myocardial injury in patients undergoing off-pump coronary artery bypass (OPCAB) grafting. One hundred and sixty-two patients who were undergoing OPCAB surgery were randomly divided into control and dexmedetomidine groups (groups C and Dex, respectively). Following the first vascular anastomosis grafting, the patients in group Dex received a continuous intravenous infusion of 0.2–0.5 μg/kg/h dexmedetomidine, until they were transferred to the Cardiac Surgery intensive care unit (ICU) for 12 h. Patients in group C received physiological saline intraoperatively and an intravenous infusion of 2–4 mg/kg/h isopropylphenol for postoperative sedation. Invasive arterial pressure and heart rate were continuously monitored for 5 min subsequent to entry into the operating theatre (T0), immediately following surgery (T1), 12 h post-surgery (T2), 24 h post-surgery(T3), 48 h post-surgery(T4) and 72 h post-surgery (T5). Blood samples were taken to determine the plasma levels of cardiac troponin I (cTnI) and creatine kinase-MB (CK-MB) at each time point. At 72 h post-surgery, a dynamic electrocardiogram was monitored. The blood pressure, heart rate, levels of cTnI, CK-MB, norepinephrine and cortisol, and postoperative arrhythmic events in the patients in group Dex all decreased compared with those in group C. The duration of mechanical ventilation and ICU residence time were also shorter than those in the control group (P<0.05). Dexmedetomidine reduced post-surgical myocardial injury in patients who had undergone OPCAB surgery.

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Section: Discussionmentioning

confidence: 99%

Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Ren

Zhang

Huang

et al. 2013

Experimental and Therapeutic Medicine

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“…Anecdotally, the negative chronotropic effects of dexmedetomidine have been used to treat tachycardia during off-pump coronary artery bypass surgery or in a preemptive fashion to decrease the incidence of postoperative tachyarrhythmias. [13,14] In our patient, who developed JET following CPB for TOF repair, an increase of the dexmedetomidine infusion from 0.5 to 3 µg/kg/h was temporally associated with a conversion to NSR within 15 min and the resolution of the hypotension. Previous data support the potential use of dexmedetomidine as a therapeutic agent to treat perioperative arrhythmias in the pediatric population [ Table 1].…”

Section: Discussionmentioning

confidence: 66%

“…All four patients with SVT converted to NSR. One patient with AF who failed amiodarone Ruesch and Levy [13] Persistent tachycardia in a 73-year-old male during off-pump coronary artery bypass grafting that failed to respond to esmolol Dexmedetomidine was administered as a loading dose of 1 µg/kg over 10 min followed by an infusion at 0.3 µg/kg/h. Within 15 min, the HR decreased to the desired level Chrysostomou et al [15] Retrospective, nonrandomized, observational study of 14 pediatric patients in the cardiac ICU with various arrhythmias, including JET, JAR, AET, AF, and SVT Dexmedetomidine was used as a primary treatment in nine patients and as a rescue therapy in five patients.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine controls junctional ectopic tachycardia during Tetralogy of Fallot repair in an infant

LeRiger¹,

Naguib²,

Gallantowicz³

et al. 2012

Ann Card Anaesth

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Dexmedetomidine is a highly selective α2 -adrenergic agonist approved for short-term sedation and monitored anesthesia care in adults. Although not approved for use in the pediatric population, an increasing number of reports describe its use in pediatric patients during the intraoperative period and in the intensive care unit. Dexmedetomidine can potentially have an adverse impact on the cardiovascular system secondary to its negative chronotropic and dromotropic effects. However, it is these cardiac effects that are currently being explored as a therapeutic option for the treatment of perioperative tachyarrhythmias in pediatric patients with congenital heart disease (CHD). We report the use of dexmedetomidine to treat junctional ectopic tachycardia (JET), which developed following cardiopulmonary bypass for surgical correction of Tetralogy of Fallot in a 6-week-old infant. Within 15 min of increasing the dexmedetomidine infusion from 0.5 to 3 μg/kg/h, JET converted to normal sinus rhythm. This case report provides additional anecdotal evidence that dexmedetomidine may have a therapeutic role in the treatment of perioperative tachyarrhythmias in pediatric patients with CHD. The specific effects of dexmedetomidine on the cardiac conduction system are reviewed followed by a summary of previous reports describing its use as a therapeutic agent to treat perioperative arrhythmias.

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“…The negative chronotropic properties of dexmedetomidine are well enough recognized that an anecdotal report even describes the therapeutic use of dexmedetomidine during off-pump coronary artery bypass surgery when tachycardia was unresponsive to b-adrenergic blockade. 20 To date, there are only rare reports of clinically significant bradycardia with the use of dexmedetomidine in infants and children. In a cohort of 80 children, ranging in age from 1 to 12 years, no clinically significant hypotension or bradycardia occurred with the intraoperative administration of dexmedetomidine (0.5 mg/kg) during 1 minimum alveolar concentration anesthesia with either desflurane or sevoflurane.…”

Section: Discussionmentioning

confidence: 99%

Bradycardia During Dexmedetomidine and Therapeutic Hypothermia

Tobias

2008

J Intensive Care Med

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Dexmedetomidine is a centrally acting alpha2-adrenergic agonist which is currently Food and Drug Administration-approved for the short-term (less than 24 hours) sedation of adults during mechanical ventilation. Given its beneficial physiologic effects and limited adverse effect profile, there is growing interest regarding its potential applications in the Pediatric intensive care unit patient including sedation during mechanical ventilation, procedural sedation, the treatment of withdrawal, and prevention of emergence agitation. Although generally safe and effective, occasional hemodynamic effects including bradycardia and hypotension have been reported. Clinical experience has demonstrated that bradycardia may be more common when dexmedetomidine is administered with other medications that have negative chronotropic effects. We report 2 pediatric patients with traumatic brain injury who had good long-term neurologic outcomes, but developed clinically significant bradycardia when therapeutic hypothermia was added to a sedation regimen that included dexmedetomidine and remifentanil. The role of dexmedetomidine as a neuroprotective agent is explored as well as a review presented of previous reports of bradycardia related to dexmedetomidine.

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Treatment of Persistent Tachycardia with Dexmedetomidine During Off-Pump Cardiac Surgery

Abstract: After unsuccessful treatment of intraoperative tachycardia with esmolol during off-pump revascularization, heart rate was successfully reduced with a bolus and infusion of dexmedetomidine.

Cited by 12 publications

References 6 publications

Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Protective effect of dexmedetomidine in coronary artery bypass grafting surgery

Dexmedetomidine controls junctional ectopic tachycardia during Tetralogy of Fallot repair in an infant

Bradycardia During Dexmedetomidine and Therapeutic Hypothermia

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