The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial

Abstract

ABSTRACT Background : The inflammatory response due to cardiopulmonary bypass (CBP) activates different inflammatory pathways that affect multiple organs. Dexmedetomidine is proved to affect inflammatory marker production. Objectives: Evaluation of the effect of Dexmedetomidine on the inflammatory response associated with pediatric open-heart surgery using interleukin-6 (IL-6) and interferon-gamma (INF-ɤ) levels. Methods: 61children aged between one to 8 years undergoing elective repair of non-cyanotic congenital heart disease with CPB were randomly assigned into two groups. The control group (31 patients) received normal saline, whereas the Dex group (30 patients) received an initial bolus of Dexmedetomidine 0.5 µg/kg followed immediately by infusion of 0.5 µg/kg/hr continued till the end of CPB. The level of IL-6 and INF-ɤ was measured. Hemodynamic, ICU, and hospital data were recorded. Results: IL-6 and INF -ɤ levels were increased significantly with time in control group, with no increase in their levels in the Dex group. They were significantly lower in the Dex group compared to the control group in samples taken during bypass, 6 h and 24 h after the operation (the end of surgical procedure). There was a significant difference between the groups regarding inotropic score and mechanical ventilation. There was no significant difference between the groups regarding complications, duration of ICU or hospital stay. Conclusion: The use of Dexmedetomidine in pediatric cardiac surgery for non-cyanotic heart disease had significantly attenuated the inflammatory response. It was useful in decreasing the level of inflammatory mediators, inotropic support, and duration of mechanical ventilation, but not the ICU or hospital stay. Trial registration: https://clinicaltrials.gov. (Identifier: NCT03163238).