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Dexmedetomidine sedation in children after cardiac surgery*

Hosokawa, Koji MD; Shime, Nobuaki MD, PhD; Kato, Yuko MD, PhD; Taniguchi, Ayano MD; Maeda, Yoshinobu MD; Miyazaki, Takako MD; Hashimoto, Satoru MD, PhD

Pediatric Critical Care Medicine: January 2010 - Volume 11 - Issue 1 - p 39-43
doi: 10.1097/PCC.0b013e3181b062d7
Cardiac Intensive Care

Objective: To study the efficacy and safety of dexmedetomidine before and after early extubation after pediatric cardiac surgery.

Design: Prospective, observational study.

Setting: University hospital pediatric intensive care.

Participants: Infants and children undergoing cardiac surgery.

Interventions: The 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 μg/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 Results: The 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.

Conclusions: A 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.

From the Department of Anesthesiology and Intensive Care (KH, NS, YK, AT, SH) and the Department of Cardiovascular and Thoracic Surgery (YM, TM), University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan.

*See also p. 148.

Drs. Hosokawa and Shime contributed equally to this study as first authors.

This work was supported, in part, by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science, Sports and Culture of Japan (NS).

The authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies