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Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patients

Kimberly N. Le| Brady S. Moffett| Elena C. Ocampo| John Zaki| Emad B. Mossad
Pediatric Original
Volume 37, Issue 4 / April , 2011

Pages 686 - 690

Abstract

Purpose

To evaluate the impact of dexmedetomidine on early extubation in post-operative pediatric cardiac patients compared to patients on standard sedation regimens without dexmedetomidine.

Methods

Retrospective study comparing dexmedetomidine infusion (DEX) to our standard sedation regimens (control).

Results

A total of 269 patients were included (control: n = 180; DEX: n = 89). The mean duration of DEX was 34 ± 2 h. Extubation was achieved in the operating room in 42% of the control group and 42% of the DEX group. Extubation within 24 h of surgery was achieved in 75% of the control group and 76% of the DEX group. Ventilator time in the DEX group was 35 ± 29 h compared to 29 ± 35 h in the control group. The mean cardiovascular intensive care unit (CV ICU) and hospital length of stays were 3 ± 2 and 8 ± 4 days in the DEX group and 3 ± 3 and 8 ± 5 days in the control group. Reintubation rates in the CV ICU were not significantly different. DEX patients received significantly less total intraoperative fentanyl and midazolam but significantly more midazolam rescue doses than the control group in the postoperative period. Post-extubation ventilation was clinically similar in the DEX group as measured by 1 h post-extubation PaCO2 levels.

Conclusions

Dexmedetomidine did not significantly impact the postoperative course of children compared to standard practice as measured by success of early extubation, ventilator time, and length of stay.

Keywords

References

  1. Triltsch AE, Welte M, von Homeyer P, Grosse J, Genähr A, Moshirzadeh M, Sidiropoulos A, Konertz W, Kox WJ, Spies CD (2002) Bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study. Crit Care Med 30:1007–1014
    • View reference on publisher's website
    • View reference on PubMed
  2. Belleville JP, Ward DS, Bloor BC, Maze M (1992) Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 77:1125–1133
    • View reference on publisher's website
    • View reference on PubMed
  3. Chrysostomou C, Di Filippo S, Manrique AM, Schmitt CG, Orr RA, Casta A, Suchoza E, Janosky J, Davis PJ, Munoz R (2006) Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med 7:126–131
    • View reference on publisher's website
    • View reference on PubMed
  4. Hosokawa K, Shime N, Kato Y, Taniguchi A, Maeda Y, Miyazaki T, Hashimoto S (2010) Dexmedetomidine sedation in children after cardiac surgery. Pediatr Crit Care Med 11:39–43
    • View reference on publisher's website
    • View reference on PubMed
  5. Arpino PA, Kalafatas K, Thompson BT (2008) Feasibility of dexmedetomidine in facilitating extubation in the intensive care unit. J Clin Pharm Ther 33:25–30
    • View reference on publisher's website
    • View reference on PubMed
  6. Bhana N, Goa KL, McClellan K (2000) Dexmedetomidine. Drugs 59:263–268
    • View reference on publisher's website
    • View reference on PubMed
  7. Manrique AM, Feingold B, Di Filippo S, Orr RA, Kuch BA, Munoz R (2007) Extubation after cardiothoracic surgery in neonates, children, and young adults: one year of institutional experience. Pediatr Crit Care Med 8:552–555
    • View reference on publisher's website
  8. Bloor BC, Ward DS, Belleville JP, Maze M (1992) Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 77:1134–1142
    • View reference on publisher's website
    • View reference on PubMed
  9. Tobias JD, Berkenbosch JW (2004) Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazalom. South Med J 97:451–455
    • View reference on publisher's website
    • View reference on PubMed
  10. Chrysostomou C, Sanchez De Toledo J, Avolio T, Motoa MV, Berry D, Morell VO, Orr R, Munoz R (2009) Dexmedetomidine use in a pediatric cardiac intensive care unit: can we use it in infants after cardiac surgery? Pediatr Crit Care Med 10:654–660
    • View reference on publisher's website
    • View reference on PubMed
  11. Vilo S, Rautiainen P, Kaisti K, Aantaa R, Scheinin M, Manner T, Olkkola KT (2008) Pharmacokinetics of intravenous dexmedetomidine in children under 11 yr of age. Br J Anaesth 100:697–700
    • View reference on publisher's website
    • View reference on PubMed

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