Efficacy and Safety of Postoperative Dexmedetomidine Administration in Infants and Children Undergoing Cardiac Surgery: A Retrospective Cohort Study.

Abstract

In this retrospective cohort study, we describe efficacy and safety of dexmedetomidine administration in the cardiac intensive care unit, in children undergoing cardiac surgery. This study consisted of pediatric patients 3 days to 17.5 years of age, undergoing cardiac surgery from April 2010 to April 2011. In addition to a scheduled opioid, usually fentanyl, 107 patients received dexmedetomidine postoperatively, including 19 (18%) patients diagnosed with trisomy 21 and 9 (8%) neonates/newborns. Median dexmedetomidine starting dose was 0.45 µg/kg/h and overall median dose higher than previously published, ranging from 0.8 µg/kg/h to 2.17 µg/kg/h. We compared infants (younger than 1 year) with older children (1-17 years of age). Median duration of administration was 1.6 days (0-23.9 days) and duration to extubation in infants was 46.5 hours, and in the older children it was 22.6 hours. Seven patients (6.5%) were discontinued dexmedetomidine due to adverse events, most commonly bradycardia. Neonates experienced more pronounced heart rate reduction (no bradycardia) and received lower maintenance doses than older infants (0.56 vs. 0.77 µg/kg/h). The face, leg, activity, cry, consolability pain scale and the state behavioral scale scores indicated adequate sedation and good analgesia. The most common adverse reaction postdiscontinuation was agitation, more frequent in the infant group (20 vs. 11.2%). Thirty patients (28.3%) received prolonged infusion (>72 hours). Patients with and without trisomy 21 did not differ with dose, safety, efficacy, or adverse events. Dexmedetomidine, as part of multimodal management, appears to be a safe, efficacious agent providing analgesia and sedation throughout all pediatric age groups following cardiac surgery. Overall, dexmedetomidine is well tolerated and safe with higher doses than previously noted, and is well tolerated by neonates, infants, and patients with trisomy 21. Withdrawal effects were noted in patients following prolonged infusion.