Abstract
Background. The purpose of this study was to access the effects of dexmedetomidine-fentanyl infusion on blood pressure (BP) and heart rate (HR) before surgical stimulation, on their changes to skin incision, and on isoflurane requirement during cardiac surgery in children. Methods. This study had a prospective, randomized, and open-label design. Thirty-two children aged 1 month to 10 years undergoing surgery for repair congenital heart disease (CHD) with CPB were randomly allocated into two groups: group MDZ received midazolam 0.2 mg·kg−1·h−1 and group DEX received dexmedetomidine 1 μg·kg−1·h−1 during the first hour followed by half of these rates of infusions thereafter. Both group received fentanyl 10 μg·kg−1, midazolam 0.2 mg·kg−1 and vecuronium 0.2 mg·kg−1 for induction. These same doses of fentanyl and vecuronium were infused during the first hour then reduced to half. The infusions started after induction and maintained until the end of surgery. Isoflurane was given briefly to control hyperdynamic response to skin incision and sternotomy. Results. In both groups, systolic blood pressure (sBP) and heart rate (HR) decreased significantly after one hour of infusion of the anesthetic solutions, but there were significantly less increase in diastolic blood pressure, sBP, and HR, and less patients required isoflurane supplementation to skin incision in the patients of the DEX group. Discussion. Dexmedetomidine infusion without a bolus appears to be an effective adjunct to fentanyl anesthesia in control of hemodynamic responses to surgery for repair of CHD in children.
Highlights
Midazolam (MDZ) is commonly combined with fentanyl for pediatric congenital heart disease (CHD) in order to provide hypnosis and deepening of the anesthetic level
Two neonates of the DEX group were excluded from analysis because they required norepinephrine to maintain blood pressure (BP) about 20 minute of induction: one 3 days old with IAoA receiving PGE2, dopamine, and milrinone infusions and the other 18 days old receiving PGE2, milrinone, and furosemide infusions
Preoperative cyanosis was significantly more frequent in the DEX group, and more than 50% of the patients in both groups were in heart rate (HR) systolic blood pressure (sBP)
Summary
Midazolam (MDZ) is commonly combined with fentanyl for pediatric congenital heart disease (CHD) in order to provide hypnosis and deepening of the anesthetic level. Thirty-two children aged 1 month to 10 years undergoing surgery for repair congenital heart disease (CHD) with CPB were randomly allocated into two groups: group MDZ received midazolam 0.2 mg·kg−1·h−1 and group DEX received dexmedetomidine 1 μg·kg−1·h−1 during the first hour followed by half of these rates of infusions thereafter. Both group received fentanyl 10 μg·kg−1, midazolam 0.2 mg·kg−1 and vecuronium 0.2 mg·kg−1 for induction. Dexmedetomidine infusion without a bolus appears to be an effective adjunct to fentanyl anesthesia in control of hemodynamic responses to surgery for repair of CHD in children
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