Dexmedetomidine sedation in children after cardiac surgery.
Pediatr Crit Care Med
; 11(1): 39-43, 2010 Jan.
Article
in En
| MEDLINE
| ID: mdl-19593247
ABSTRACT
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 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 MAINRESULTS:
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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Dexmedetomidine
/
Cardiac Surgical Procedures
/
Hypnotics and Sedatives
Type of study:
Observational_studies
/
Risk_factors_studies
Limits:
Adolescent
/
Child
/
Child, preschool
/
Female
/
Humans
/
Infant
/
Male
Country/Region as subject:
Asia
Language:
En
Journal:
Pediatr Crit Care Med
Journal subject:
PEDIATRIA
/
TERAPIA INTENSIVA
Year:
2010
Document type:
Article
Affiliation country:
Japan
Publication country:
EEUU
/
ESTADOS UNIDOS
/
ESTADOS UNIDOS DA AMERICA
/
EUA
/
UNITED STATES
/
UNITED STATES OF AMERICA
/
US
/
USA