• Dian Kesumarini, Yunita Widyastuti, Cindy Elfira Boom, and Lucia Kris Dinarti.
• Department of Anesthesia and Intensive Therapy, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. Electronic address: diankesumarini@gmail.com.
• J. Cardiothorac. Vasc. Anesth. 2024 Jun 1; 38 (6): 136913771369-1377.

ObjectivesEfficacy of dexmedetomidine (DEX) as a cardioprotective agent in Indonesian children undergoing classic tetralogy of Fallot (TOF) repair with cardiopulmonary bypass (CPB).DesignA prospective, parallel trial using block randomization along with double-blinded preparation of treatment agents by other parties.SettingNational Cardiovascular Center Harapan Kita, Indonesia.ParticipantsSixty-six children with classic TOF scheduled for corrective surgery. No children were excluded. All patients had fulfilled the criteria for analysis.InterventionsA total of 0.5 µg/kg bolus of DEX was added to the CPB priming solution, followed by 0.25 µg/kg/h maintenance during bypass. The placebo group used normal saline. Follow-ups were up to 30 days.Measurements And Main ResultsTroponin I was lower in the DEX group at 6 hours (30.48 ± 19.33 v 42.73 ± 27.16, p = 0.039) and 24 hours after CPB (8.89 ± 5.42 v 14.04 ± 11.17, p = 0.02). Within a similar timeframe, DEX successfully lowered interleukin-6 (p = 0.03; p = 0.035, respectively). Lactate was lower in the Dex group at 1, 6, and 24 hours after CPB (p < 0.01; p = 0.048; p = 0.035; respectively). Dexmedetomidine increased cardiac output and index from 6 hours after bypass, but vice versa in systemic vascular resistance. Reduction of vasoactive inotropic score was seen during intensive care unit monitoring in the Dex group (p = 0.049). Nevertheless, DEX did not significantly affect the length of ventilation (p = 0.313), intensive care unit stay (p = 0.087), and mortality (p > 0.99).ConclusionsDexmedetomidine during CPB is an effective cardioprotective agent in TOF children having surgery. Postoperative mortality was comparable across groups.Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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