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Dexmedetomidine utilisation and outcomes of children with trisomy 21 undergoing congenital heart disease surgery

Published online by Cambridge University Press:  27 August 2014

Brady S. Moffett ,
Emad B. Mossad ,
Joseph D. Tobias  and
Antonio G. Cabrera
Brady S. Moffett*
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America
Emad B. Mossad
Affiliation:
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, United States of America
Joseph D. Tobias
Affiliation:
Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
Antonio G. Cabrera
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: B. S. Moffett, PharmD, MPH, Department of Pharmacy, Texas Children’s Hospital, 6621 Fannin Street, Suite WB 1120, Houston, TX 77030, United States of America. Tel: +832 824 6087; Fax: 832 825 5261; E-mail: bsmoffet@texaschildrens.org
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Abstract

Introduction: The diagnosis of trisomy 21 in children has been associated with failed extubation after CHD surgery. Dexmedetomidine may be a useful agent to improve postoperative outcomes in these patients, such as ventilator time, ICU length of stay, or hospital length of stay. Materials and methods: The Pediatric Health Information System database was queried from January, 2008 to December, 2010 for patients with trisomy 21 who underwent CHD surgery. Patients who received dexmedetomidine were matched to patients who did not by propensity score. The primary outcome was ventilator days charged, and secondary outcomes included ICU and hospital length of stay. Results: A total of 1088 patients (544 matched pairs) met inclusion criteria. Patient characteristics were similar, with the exception of more patients in the dexmedetomidine group undergoing repair of complete atrioventricular canal and fewer undergoing mechanical valve replacement (p<0.01). More patients in the dexmedetomidine group were administered milrinone, epinephrine, vasopressin, benzodiazepines, opiates, and adjunct pain and sedative medications (p<0.01). The dexmedetomidine group had greater time on the ventilator [7 (4.5–11) versus 6 (4–10) days (median, interquartile range) p<0.01] and similar ICU length of stay, hospital length of stay, and mortality compared with controls. Mixed-effects modelling clustered on institution did not show beneficial effect of dexmedetomidine on ventilator time, ICU stay, or hospital length of stay. Conclusions: The use of dexmedetomidine was not associated with the decreased ventilatory time. Routine use of dexmedetomidine is not warranted in this patient population.

Keywords

Dexmedetomidinetrisomy 21ventilatorcardiac surgerypaediatric
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 958 - 962
Copyright
© Cambridge University Press 2014 

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References

1. Reiter, PD, Pietras, M, Dobyns, EL. Prolonged dexmedetomidine infusions in critically ill infants and children. Indian Pediatr 2009; 46: 767–773.Google Scholar
2. Hosokawa, K, Shime, N, Kato, Y, et al. Dexmedetomidine sedation in children after cardiac surgery. Pediatr Crit Care Med 2010; 11: 39–43.Google Scholar
3. Hammer, GB. Con: dexmedetomidine should not be used for infants and children during cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 152–154.Google Scholar
4. Easley, RB, Tobias, JD. Pro: dexmedetomidine should be used for infants and children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22: 147–151.Google Scholar
5. Chrysostomou, C, Di, FS, Manrique, AM, et al. Use of dexmedetomidine in children after cardiac and thoracic surgery. Pediatr Crit Care Med 2006; 7: 126–131.Google Scholar
6. Chrysostomou, C, Sanchez De Toledo, J, Avolio, T, et al. Dexmedetomidine use in a pediatric cardiac intensive care unit: can we use it in infants after cardiac surgery? Pediatr Crit Care Med 2009; 10: 654–660.CrossRefGoogle Scholar
7. Bejian, S, Valasek, C, Nigro, JJ, Cleveland, DC, Willis, BC. Prolonged use of dexmedetomidine in the paediatric cardiothoracic intensive care unit. Cardiol Young 2009; 19: 98–104.Google Scholar
8. Butler, MG, Hayes, BG, Hathaway, MM, Begleiter, ML. Specific genetic diseases at risk for sedation/anesthesia complications. Anesth Analg 2000; 91: 837–855.Google Scholar
9. Kalyanaraman, M, Costello, JL, Starr, JP. Use of dexmedetomidine in patients with trisomy 21 after cardiac surgery. Pediatr Cardiol 2007; 28: 396–399.CrossRefGoogle ScholarPubMed
10. Pandit, C, Fitzgerald, DA. Respiratory problems in children with Down syndrome. J Paediatr Child Health 2012; 48: E147–E152.Google Scholar
11. Pasquali, SK, Gaies, MG, Jacobs, JP, William, GJ, Jacobs, ML. Centre variation in cost and outcomes for congenital heart surgery. Cardiol Young 2012; 22: 796–799.CrossRefGoogle ScholarPubMed
12. Ungerleider, RM, Pasquali, SK, Welke, KF, et al. Contemporary patterns of surgery and outcomes for aortic coarctation: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2013; 145: 150–157.Google Scholar
13. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110–118.Google Scholar
14. Tokuhira, N, Atagi, K, Shimaoka, H, Ujiro, A, Otsuka, Y, Ramsay, M. Dexmedetomidine sedation for pediatric post-Fontan procedure patients. Pediatr Crit Care Med 2009; 10: 207–212.Google Scholar
15. Le, KN, Moffett, BS, Ocampo, EC, Zaki, J, Mossad, EB. Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patients. Intensive Care Med 2011; 37: 686–690.Google Scholar
16. Lazol, JP, Lichtenstein, SE, Jooste, EH, et al. Effect of dexmedetomidine on pulmonary artery pressure after congenital cardiac surgery: a pilot study. Pediatr Crit Care Med 2010; 11: 589–592.Google Scholar
17. Zhang, X, Schmidt, U, Wain, JC, Bigatello, L. Bradycardia leading to asystole during dexmedetomidine infusion in an 18 year-old double-lung transplant recipient. J Clin Anesth 2010; 22: 45–49.Google Scholar
18. Shepard, SM, Tejman-Yarden, S, Khanna, S, Davis, CK, Batra, AS. Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery. Crit Care Med 2011; 39: 187–189.Google Scholar
19. Potts, AL, Anderson, BJ, Holford, NH, Vu, TC, Warman, GR. Dexmedetomidine hemodynamics in children after cardiac surgery. Paediatr Anaesth 2010; 20: 425–433.Google Scholar
20. Klamt, JG, Vicente, WV, Garcia, LV, Ferreira, CA. Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass. Rev Bras Anestesiol 2010; 60: 350–362.Google Scholar
21. Jooste, EH, Muhly, WT, Ibinson, JW, et al. Acute hemodynamic changes after rapid intravenous bolus dosing of dexmedetomidine in pediatric heart transplant patients undergoing routine cardiac catheterization. Anesth Analg 2010; 111: 1490–1496.Google Scholar
22. Chrysostomou, C, Komarlu, R, Lichtenstein, S, et al. Electrocardiographic effects of dexmedetomidine in patients with congenital heart disease. Intensive Care Med 2010; 36: 836–842.CrossRefGoogle ScholarPubMed