The effects of dexmedetomidine administration on the pulmonary artery pressure and the transpulmonary pressure gradient after the bidirectional superior cavopulmonary shunt.

Abstract

The hemodynamic effects of dexmedetomidine (DEX) on pulmonary artery pressure (PAP) are not fully understood in patients with a single-ventricle physiology. The objective of this retrospective study was to characterize the effect of perioperative DEX infusion on PAP and the transpulmonary pressure gradient after a bidirectional superior cavopulmonary shunt (BCPS) operation. We retrieved physiologic data including the heart rate, incidence of cardiac pacing, systolic and diastolic arterial blood pressure (ABP), and superior vena cava (SVC) and inferior vena cava (IVC) pressures from the medical records of all patients <12 months of age who underwent a BCPS operation. Patients with an additional Norwood or Damus-Kaye-Stansel procedure, those with additional pulmonary blood flow, and those without both a SVC and an IVC catheter were excluded from the present study. Following the BCPS operation, the SVC pressure is equivalent to the PAP. Similarly, the IVC pressure is equivalent to the common atrial pressure (CAP). Accordingly, we can directly assess the transpulmonary pressure gradient, defined as the difference between the PAP and the CAP, using simultaneous SVC and IVC pressure measurements. Twenty-nine patients were included in the present study. We did not find any increase in the PAP, CAP, PAP/systolic ABP ratio, or the transpulmonary pressure gradient as of 6 h after admission to the intensive care unit when the patients were treated with DEX infusion at a median (interquartile ranges) dose of 0.6 mcg/kg/h (0.4, 0.64 mcg/kg/h). We concluded that the administration of DEX to children with a single-ventricle physiology is acceptable.