Articles

The Effects of Dexmedetomidine Prescription in Paediatric Patients With Pulmonary Hypertension Under Congenital Heart Surgery

Abstract

Anesthetized patient management for pediatric patients with pulmonary arterial hypertension (PAH) is a major challenge. The aim of this study was to evaluate the ability of dexmedetomidine to reduce pulmonary arterial hypertension in patients with pulmonary arterial hypertension undergoing cardiac surgery. Sixty-six patients with pulmonary arterial hypertension underwent the study. Patients were randomly divided into two groups: group D received a dexmedetomidine injection in a dose of 1 μg/kg in the first hour and then decreased to 0.5 μg/kg/hr, injection continued after surgery until extubation in the post-anesthetic care unit (PACU). Group C received normal saline 0.9% in a similar volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded during and after the surgery in the post-anesthetic care unit. Needing vasodilators, sedatives, extubation time, and the length of ICU stay were recorded for all patients. Patients in the dexmedetomidine group showed a significant reduction in Pulmonary artery systolic pressure and Pulmonary artery systolic pressure/systemic systolic blood pressure rates during surgery and during the first 24 hours in the post-anesthetic care unit (P<0.001). The dexmedetomidine group, in comparison with the control group, needed a significantly lower dose of a vasodilator (P<0.001) and a lower dose of sedation (P<0.001). It is concluded that the use of dexmedetomidine during the surgery in children with pulmonary hypertension reduces pulmonary artery systolic pressure during and after the surgery.

1. Abdel-Hamid HM, Abdel-Azziz MM, Omar AHA. The effect of perioperative use of dexmedetomidine on pediatric patients with pulmonary hypertension undergoing congenital cardiac surgery. Ain-Shams Journal of Anaesthesiology. 2017;10(1):10.
2. Barst RJ, McGoon MD, Elliott CG, Foreman AJ, Miller DP, Ivy DD. Survival in childhood pulmonary arterial hypertension: insights from the registry to evaluate early and long-term pulmonary arterial hypertension disease management. Circulation. 2012;125(1):113-22.
3. Barton KP, Munoz R, Morell VO, Chrysostomou C. Dexmedetomidine as the primary sedative during invasive procedures in infants and toddlers with congenital heart disease. Pediatric Critical Care Medicine. 2008;9(6):612-5.
4. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77(6):1125-33.
5. Berger RM, Beghetti M, Humpl T, Raskob GE, Ivy DD, Jing Z-C, et al. Clinical features of paediatric pulmonary hypertension: a registry study. The Lancet. 2012;379(9815):537-46.
6. Berkenbosch JW, Wankum PC, Tobias JD. Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children. Pediatric Critical Care Medicine. 2005;6(4):435-9.
7. Chrysostomou C, Beerman L, Shiderly D, Berry D, Morell VO, Munoz R. Dexmedetomidine: a novel drug for the treatment of atrial and junctional tachyarrhythmias during the perioperative period for congenital cardiac surgery: a preliminary study. Anesthesia & Analgesia. 2008;107(5):1514-22.
8. Chrysostomou C, Sanchez-de-Toledo J, Wearden P, Jooste EH, Lichtenstein SE, Callahan PM, et al. Perioperative use of dexmedetomidine is associated with decreased incidence of ventricular and supraventricular tachyarrhythmias after congenital cardiac operations. The Annals of thoracic surgery. 2011;92(3):964-72.
9. Dyck J, Shafer S. Dexmedetomidine pharmacokinetics and pharmacodynamics. Anaesth Pharmacol Rev. 1993;1:238-45.
10. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2000;93(2):382-94.
11. Gupta P, Whiteside W, Sabati A, Tesoro TM, Gossett JM, Tobias JD, et al. Safety and efficacy of prolonged dexmedetomidine use in critically ill children with heart disease. Pediatric critical care medicine. 2012;13(6):660-6.
12. Klamt JG, Vicente WVdA, Garcia LV, Ferreira CA. Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass. Revista brasileira de anestesiologia. 2010;60(4):356-62.
13. Kozlik-Feldmann R, Hansmann G, Bonnet D, Schranz D, Apitz C, Michel-Behnke I. Pulmonary hypertension in children with congenital heart disease (PAH-CHD, PPHVD-CHD). Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK. Heart. 2016;102(Suppl 2):ii42-ii8.
14. Lazol JP, Lichtenstein SE, Jooste EH, Shiderly D, Kudchadker NA, Tatum GH, et al. Effect of dexmedetomidine on pulmonary artery pressure after congenital cardiac surgery: a pilot study. Pediatric Critical Care Medicine. 2010;11(5):589-92.
15. Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. LWW; 2006.
16. Oishi P, Datar SA, Fineman JR. Advances in the management of pediatric pulmonary hypertension. Respiratory Care; 2011.
17. Reves J, Karp RB, Buttner EE, Tosone S, Smith LR, Samuelson PN, et al. Neuronal and adrenomedullary catecholamine release in response to cardiopulmonary bypass in man. Circulation. 1982;66(1):49-55.
18. Sharma VK, Joshi S, Joshi A, Kumar G, Arora H, Garg A. Does intravenous sildenafil clinically ameliorate pulmonary hypertension during perioperative management of congenital heart diseases in children?–A prospective randomized study. Annals of cardiac anaesthesia. 2015;18(4):510.
19. Snapir A, Posti J, Kentala E, Koskenvuo J, Sundell J, Tuunanen H, et al. Effects of low and high plasma concentrations of dexmedetomidine on myocardial perfusion and cardiac function in healthy male subjects. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2006;105(5):902-10.
20. Tobias JD, Gupta P, Naguib A, Yates AR. Dexmedetomidine: applications for the pediatric patient with congenital heart disease. Pediatric Cardiology. 2011;32(8):1075-87.
Files
IssueVol 58, No 4 (2020) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v58i4.3922
Keywords
Congenital cardiac surgery Dexmedetomidine Pulmonary hypertension
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Ghasemzadeh B, Azizi B, Azemati S, Bagherinasab M. The Effects of Dexmedetomidine Prescription in Paediatric Patients With Pulmonary Hypertension Under Congenital Heart Surgery. Acta Med Iran. 2020;58(4):171-176.