• Koji Hosokawa, Nobuaki Shime, Yuko Kato, Ayano Taniguchi, Yoshinobu Maeda, Takako Miyazaki, and Satoru Hashimoto.
• Department of Anesthesiology and Intensive Care, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.
• Pediatr Crit Care Me. 2010 Jan 1;11(1):39-43.

ObjectiveTo study the efficacy and safety of dexmedetomidine before and after early extubation after pediatric cardiac surgery.DesignProspective, observational study.SettingUniversity hospital pediatric intensive care.ParticipantsInfants and children undergoing cardiac surgery.InterventionsThe 141 patients, depending on the treatment period, were divided between: 1) usual, postoperative, continuous, intravenous sedation with chlorpromazine, midazolam, or fentanyl (n = 85); and 2) treatment with dexmedetomidine, 0.4 to 0.6 microg/kg/hr (n = 56). Sedation was titrated to reach a Ramsay score of 4 or 5 by administering rescue boluses, as needed.Measurements And Main ResultsThe primary and secondary study end points were efficacy of sedation and frequency of adverse events, respectively. The numbers of rescue boluses needed and the proportion of ineffectively sedated patients were similar in both groups. The frequency of bradycardia or hypotension in the dexmedetomidine group was 21.4% (8.2% in usual sedative group, p = .04), requiring interventions to restore hemodynamic stability in 5.3% of patients (0% in usual sedative group, p = .06). Rates of respiratory depression (8.2% vs. 0%, p = .04) and involuntary movements (15.3% vs. 3.6%, p = .01) were higher in the usual sedation group.ConclusionsA usual sedation regimen and dexmedetomidine were similarly efficacious. Although dexmedetomidine was associated with a lower rate of respiratory depression, it caused a higher rate of adverse hemodynamic events, which might be a concern in hemodynamically unstable patients.

22 keywords...

hide…