Effectiveness of Dexmedetomidine as Myocardial Protector in Children With Classic Tetralogy of Fallot Having Corrective Surgery: A Randomized Controlled Trial

Abstract

ObjectivesEfficacy of dexmedetomidine as cardioprotective agent in Indonesian children undergoing classic tetralogy of Fallot (TOF) repair with cardiopulmonary bypass (CPB). DesignA prospective, parallel trial utilizing block randomization along with double-blinded preparation of treatment agents by other parties. SettingNational Cardiovascular Center Harapan Kita, Indonesia. Participants66 children with classic TOF scheduled for corrective surgery. No children were excluded. All patients had fulfilled criteria for analysis. Interventions0.5 mcg/kg bolus of dexmedetomidine was added in CPB priming solution, followed by 0.25 mcg/kg/hour maintenance during bypass. Placebo group used normal saline. Follow-ups were up to 30 days. Measurement and Main ResultsTroponin I was lower in the dexmedetomidine (Dex) group at 6 hours (30.48± 19.33 vs. 42.73± 27.16, p = 0.039) and 24 hours after CPB (8.89± 5.42 vs. 14.04± 11.17, p = 0.02). Within similar timeframe, Dexmedetomidine successfully lowered IL-6 (p = 0.03; p = 0.035, respectively). Lactate was lower in the Dex group at 1, 6, and 24 hours after CPB (p = <0.01; p = 0.048; p = 0.035, respectively). Dexmedetomidine increased cardiac output and index from 6 hours after bypass, but vice versa in systemic vascular resistance. Reduction of vasoactive inotropic score was seen during ICU monitoring in the Dex group (p = 0.049). Nevertheless, dexmedetomidine did not significantly affect length of ventilation (p = 0.313), ICU stay (p = 0.087), and mortality (p >0.99). ConclusionsDexmedetomidine during CPB is an effective cardioprotective agent in TOF children having surgery. Postoperative mortality was comparable across groups.