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The Perioperative Use of Dexmedetomidine in Pediatric Patients with Congenital Heart Disease: An Analysis from the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons Congenital Heart Disease Database

Schwartz, Lawrence I. MD; Twite, Mark MA, MBBChir; Gulack, Brian MD; Hill, Kevin MD; Kim, Sunghee PhD; Vener, David F. MD

doi: 10.1213/ANE.0000000000001314
Pediatric Anesthesiology: Original Clinical Research Report

BACKGROUND: Dexmedetomidine is a selective α-2 receptor agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic for pediatric patients with congenital heart disease (CHD). Although several smaller, single-center studies suggest that dexmedetomidine use is gaining traction in the perioperative setting in children with CHD, there are limited multicenter data, with little understanding of the variation in use across age ranges, procedural complexity, and centers. The aim of this study was to use the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons (CCAS-STS) registry to describe patient- and center-level variability in the use of dexmedetomidine in the perioperative setting in children with heart disease.

METHODS: To describe the use of dexmedetomidine in patients for CHD surgery, we analyzed all index cardiopulmonary bypass operations entered in the CCAS-STS database from 2010 to 2013. Patient and operative characteristics were compared between those who received intraoperative dexmedetomidine and those who did not. Selective outcomes associated with dexmedetomidine use were also described.

RESULTS: Of the 12,142 operations studied, 3600 (29.6%) received perioperative dexmedetomidine (DEX) and 8542 did not receive the drug (NoDEX). Patient characteristics were different between the 2 groups with the DEX group generally exhibiting both lower patient and procedural risk factors. Patients who received dexmedetomidine were more likely to have a lower level of Society of Thoracic Surgeons mortality complexity than patient who did not receive it. Consistent with their overall lower risk profile, children in the DEX group also demonstrated improved outcomes compared with patients who did not receive dexmedetomidine.

CONCLUSIONS: We described the growing use of dexmedetomidine in children anesthetized for surgical repair of CHD. Dexmedetomidine appears to be preferentially given to older and larger children who are undergoing less complex CHD surgery. We believe that the data provided in this study are the largest investigating the use of an anesthetic drug in CHD patients. It is also the first analysis of the anesthesia data in the CCAS-STS Congenital Heart Disease database.

Published ahead of print May 10, 2016

From the *Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado, Aurora, Colorado; Department of Surgery, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina; Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina; §Department of Biostatistics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina; and Department of Anesthesiology, Pediatric Cardiovascular Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas.

Accepted for publication February 24, 2016.

Published ahead of print May 10, 2016

Funding: STS Database Participation.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Lawrence I. Schwartz, MD, Children’s Hospital Colorado, University of Colorado, E 16th Ave, B090, Aurora, CO 80111. Address e-mail to Lawrence.Schwartz@childrenscolorado.org.

© 2016 International Anesthesia Research Society
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