Use of dexmedetomidine in pediatric cardiac anesthesia

Kiski, D.; Schmidt, Christoph

doi:10.1097/aco.0000000000000731

Cited by 38 publications

(30 citation statements)

References 48 publications

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“…39 On the other hand, it can produce sedative and analgesic effects, and synergise with local anaesthetics to achieve spinal block. 40 Besides, it may inhibit norepinephrine secretion in the spinal cord, excite cholinergic nerves and play a synergistic anti-nociceptive effect. 41 Furthermore, dexmedetomidine is highly fat-soluble, and it is easily absorbed into the epidural adipose tissue into the blood.…”

Section: Discussionsmentioning

confidence: 99%

“…On the one hand, it opens the K + channel and superimposes the cell membrane, and it strengthens the inhibitory effect of the local anaesthetic Na+ channel 39 . On the other hand, it can produce sedative and analgesic effects, and synergise with local anaesthetics to achieve spinal block 40 . Besides, it may inhibit norepinephrine secretion in the spinal cord, excite cholinergic nerves and play a synergistic anti‐nociceptive effect 41 .…”

Section: Discussionmentioning

confidence: 99%

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Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Qian

Gao

Liu

et al. 2020

Int. J. Clin. Pract.

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Epidural anaesthesia can provide satisfactory analgesic and muscle relaxation effects, and it has been widely used in lower abdominal and lower limb orthopaedic surgery clinically. 1,2 Analgesic drugs can be given through an epidural catheter after surgery, which is a safe and effective method for treating acute postoperative pain. 3 Studies 4,5 have shown that compared with the use of a single drug for postoperative analgesia, multimodal analgesia with different technologies can reduce the dose of opioids and have better analgesic effects. Ropivacaine is an amide-type local anaesthetic, which has less central nervous system and cardiovascular toxicity, and has better delayed gaps on the sensory and motor nerve block. 6 It's been reported that the use of ropivacaine in the orthopaedic surgery of lower limb can facilitate the recovery of patients. 7 When the combination of opioids and local anaesthetics is used in epidural analgesia, it has a significant synergistic effect, which can enhance the analgesic effect, prolong the analgesic time, reduce the concentration and dosage of local anaesthetics, and improve patient satisfaction. 8 However, the combination of opioids and local anaesthetics may be also complicated with many side effects. Previous studies 9,10 have reported that the combined use may cause side effects such as nausea and vomiting, skin itching and urinary retention, which are poorly tolerated by patients. Therefore, it is necessary to seek a better way of anaesthesia.

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Section: Discussionsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Qian

Gao

Liu

et al. 2020

Int. J. Clin. Pract.

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“…It is also well known that benzodiazepine exposure is associated with an increased incidence of delirium, longer duration of delirium, and decreased likelihood of ICU discharge [1][2][3]. While dexmedetomidine is safe and effective in the pediatric and congenital heart disease population [18][19][20][21][22], there is decreased clearance in the neonatal period [23].…”

Section: Discussionmentioning

confidence: 99%

Changes in Sedation Practices in Association with Delirium Screening in Infants After Cardiopulmonary Bypass

et al. 2021

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Sedation in the cardiac intensive care unit (CICU) is necessary to keep critically ill infants safe and comfortable. However, long-term use of sedatives may be associated with adverse neurodevelopmental outcomes. We aimed to examine sedation practices in the CICU after the implementation of the Cornell Assessment of Pediatric Delirium (CAPD). We hypothesize the use of the CAPD would be associated with a decrease in sedative weans at CICU discharge. This is a single institution, retrospective cohort study. The study inclusion criteria were term infants, birthweight > 2.5 kg, cardiopulmonary bypass (CPB), and mechanical ventilation (MV) on postoperative day zero. During the study period, 50 and 35 patients respectively, met criteria pre-and post-implementation of CAPD screening. Our results showed a statistically significant increase in the incidence of sedative habituation wean at CICU discharge after CAPD implementation (24% vs. 45.7%, p = 0.036). There was a statistically significant increase in exposure to opiate (56% vs. 88.6%, p = 0.001) and dexmedetomidine infusions (52% vs 80%, p = 0.008), increased likelihood of clonidine use at CICU discharge (OR 9.25,, and increase in the duration of intravenous sedative infusions (8.1 days vs. 5.1 days, p = 0.04) No statistical difference was found in exposure to fentanyl (42% vs. 58.8%, p = 0.13) or midazolam infusions (22% vs. 25.7%, p = 0.691); and there was no change in benzodiazepine or opiate use at CICU discharge or dosage. The prevalence of delirium in the CAPD cohort was 92%. CAPD implementation in the CICU was associated with changes in sedation practices, specifically an increase in the use of dexmedetomidine, which possibly explains the increased clonidine weans at CICU discharge. This is the first report of the association between CAPD monitoring and changes in sedative practices. Multi-center prospective studies are recommended to evaluate sedative practices, delirium, and its effects on neurodevelopment.

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“…Analgesia and sedation therapy is the essential treatments after pediatric cardiothoracic surgery. The sedative and analgesic drugs commonly used in pediatric cardiothoracic surgery include opioids, benzodiazepines , and dexmetomidine [6,17]. Besides, a variety of effective non-pharmacological analgesic treatment regimens have been adopted in the clinic.…”

Section: Discussionmentioning

confidence: 99%

“…However, some patients still need traditional surgery, and postoperative restlessness is inevitable. Due to the postoperative unfamiliar surroundings and the painful incision, children often feel fear and anxiety, producing negative emotions in their families, and reducing the parents' satisfaction with treatment [4][5][6]. Therefore, it is essential to reduce the pain, restlessness, and anxiety of children after cardiothoracic surgery.…”

Section: Introductionmentioning

confidence: 99%

Application and effects of an early childhood education machine on analgesia and sedation in children after cardiothoracic surgery

Chen¹,

Lei²,

Liu³

et al. 2021

J Cardiothorac Surg

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Objective To study the effect of an early childhood education machine on sedation and analgesia in children after cardiothoracic surgery. Methods A prospective randomized controlled study was conducted in a provincial hospital in China. Fifty-two patients (aged from 1 to 5 years) underwent cardiothoracic surgery (including: ventricular septal defect, patent ductus arteriosus, atrial septal defect, pulmonary stenosis, pulmonary sequestration and congenital cystic adenomatoid lung malformation) were divided into the study group (n = 26) and the control group (n = 26). The patients in the study group underwent intervention with an early childhood education machine (uniform type) in addition to routine standard treatment and nursing, while the patients in the control group only received routine standard treatment and nursing. Richmond agitation sedation score (RASS) and face, legs, activity, cry, consolability (FLACC) score of all of the patients were evaluated, and the negative emotions (self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) score) of the parents of the two groups were compared. Results There was no significant difference in the general clinical data between the two groups. The RASS and FLACC scores in the study group were significantly lower than those in the control group, and the SAS and SDS scores of the parents in the study group were significantly lower than those in the control group. Conclusion The application of an early childhood education machine for children after cardiothoracic surgery can effectively reduce postoperative agitation, improve sedation and analgesia of the patients, and ease the pessimistic mood of the patients’ parents.

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Use of dexmedetomidine in pediatric cardiac anesthesia

Cited by 38 publications

References 48 publications

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Dexmedetomidine versus fentanyl as adjuvants to ropivacaine for epidural anaesthesia: A systematic review and meta‐analysis

Changes in Sedation Practices in Association with Delirium Screening in Infants After Cardiopulmonary Bypass

Application and effects of an early childhood education machine on analgesia and sedation in children after cardiothoracic surgery

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