Dexmedetomidine: Applications for the pediatric patient with congenital heart disease

  • J.D. T
  • P. G
  • A. N
 et al. 
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Abstract

This study aimed to provide a general description of the cardiovascular and hemodynamic effects of dexmedetomidine and an evidence-based review of the literature regarding its use in infants and children with congenital heart disease (CHD). A computerized bibliographic search of the literature on dexmedetomidine use in infants and children with CHD was performed. The cardiovascular effects of dexmedetomidine have been well studied in animal and adult human models. Adverse cardiovascular effects include occasional episodes of bradycardia, with rare reports of sinus pause or cardiac arrest. Both hypotension and hypertension also have been reported. The latter is related to peripheral α2B agonism leading to vasoconstriction. No adverse effects on the pulmonary vasculature have been noted even in patients with preexisting pulmonary hypertension. Although there are no direct effects on myocardial function, decreased cardiac output may result from changes in heart rate or increases in afterload. Although not currently Food and Drug Administration (FDA)-approved for the pediatric population, findings have shown dexmedetomidine to be effective in various clinical scenarios of patients with CHD including sedation during mechanical ventilation, prevention of procedure-related anxiety, prevention of emergence delirium and shivering after anesthesia, and treatment of withdrawal. Although dexmedetomidine may have limited utility for painful or invasive procedures, preliminary data suggest that the addition of ketamine to the regimen may offer benefits. When used during the perioperative period, additional benefits include blunting of the sympathetic stress response with a reduction of endogenous catecholamine release, a decrease in intraoperative anesthetic requirements, and a limitation of postoperative opioid requirements. © 2011 Springer Science+Business Media, LLC.

Author-supplied keywords

  • Fontan procedure
  • PR interval
  • QRS complex
  • adrenergic system
  • agitation
  • amiodarone
  • antidote
  • arrhythmogenesis
  • artificial ventilation
  • atrial fibrillation
  • atrioventricular block
  • benzodiazepine
  • blood pressure
  • bradycardia
  • buprenorphine
  • cardiopulmonary bypass
  • cardiovascular effect
  • catecholamine
  • catecholamine release
  • chronotropism
  • congenital heart disease
  • coronary artery constriction
  • cytochrome P450 2A6
  • delirium
  • dexmedetomidine
  • digoxin
  • drug clearance
  • drug distribution
  • drug dose reduction
  • drug elimination
  • drug half life
  • drug potentiation
  • drug substitution
  • drug transformation
  • drug urine level
  • drug withdrawal
  • electrophysiology
  • glucuronosyltransferase
  • head movement
  • heart arrest
  • heart arrhythmia
  • heart death
  • heart muscle ischemia
  • heart muscle oxygen consumption
  • heart output
  • heart rate
  • hemodynamics
  • herniorrhaphy
  • human
  • hypercapnia
  • hypertension
  • hypoplastic left heart syndrome
  • hypotension
  • inotropism
  • intraoperative period
  • ketamine
  • lactate blood level
  • lactic acid
  • loading drug dose
  • lorazepam
  • lung artery pressure
  • lung vascular resistance
  • mastication
  • mean arterial pressure
  • midazolam
  • neuroprotection
  • nitroprusside sodium
  • nonREM sleep
  • nonhuman
  • off pump coronary surgery
  • pacemaker
  • pentazocine
  • pneumonia
  • postoperative care
  • propofol
  • pulmonary hypertension
  • pupil disease
  • pyridostigmine
  • randomized controlled trial (topic)
  • respiratory failure
  • review
  • sedation
  • shivering
  • side effect
  • sinus arrest
  • sinus node disease
  • sternotomy
  • suxamethonium
  • tachycardia
  • tranquilizing activity
  • verbal communication
  • vomiting
  • withdrawal syndrome

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Authors

  • Tobias J.D.

  • Gupta P.

  • Naguib A.

  • Yates A.R.

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