| Dexmedetomidine use in a pediatric cardiac intensive care unit: can we use it in infants after cardiac surgery? | |
| | |
MedLine Citation:
|
PMID: 19295456 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To assess clinical response of dexmedetomidine alone or in combination with conventional sedatives/analgesics after cardiac surgery. DESIGN: Retrospective study. SETTING: Pediatric cardiac intensive care unit. PATIENTS: Infants and neonates after cardiac surgery. MEASUREMENTS AND MAIN RESULTS: We identified 80 patients including 14 neonates, at mean age and weight of 4.1 +/- 3.1 months and 5.5 +/- 2 kg, respectively, who received dexmedetomidine for 25 +/- 13 hours at an average dose of 0.66 +/- 0.26 microgxkgxhr. Overall normal sleep to moderate sedation was documented 94% of the time and no pain to mild pain for 90%. Systolic blood pressure (SBP) decreased from 89 +/- 15 mm Hg to 85 +/- 11 mm Hg (p = .05), heart rate (HR) from 149 +/- 22 bpm to 129 +/- 16 bpm (p < .001), and respiratory rate (RR) remained unchanged. When baseline arterial blood gases were compared with the most abnormal values, pH decreased from 7.4 +/- 0.07 to 7.37 +/- 0.05 (p = .006), Po2 from 91 +/- 67 mm Hg to 66 +/- 29 mm Hg (p = .005), and CO2 increased from 45 +/- 8 mm Hg to 50 +/- 12 mm Hg (p = .001). At the beginning of the study, 37 patients (46%) were mechanically ventilated; and at 48 hours, 13 patients (16%) were still intubated and five patients failed extubation. Three groups of patients were identified: A, dexmedetomidine only (n = 20); B, dexmedetomidine with sedatives/analgesics (n = 38); and C, dexmedetomidine with both sedatives/analgesics and fentanyl infusion (n = 22). The doses of dexmedetomidine and rescue sedatives/analgesics were not significantly different among the three groups but duration of dexmedetomidine was longer in group C vs. A (p = .03) and C vs. B (p = .002). Pain, sedation, SBP, RR, and arterial blood gases were similar. HR was higher in group C vs. B (p = .01). Comparison between neonates and infants showed that infants required higher dexmedetomidine doses, 0.69 +/- 25 microgxkgxhr, and vs. 0.47 +/- 21 microgxkgxhr (p = .003) and had lower HR (p = .01), and RR (p = .009), and higher SBP (p < .001). CONCLUSIONS: Dexmedetomidine use in infants and neonates after cardiac surgery was well tolerated in both intubated and nonintubated patients. It provides an adequate level of sedation/analgesia either alone or in combination with low-dose conventional agents. |
| | |
Authors:
|
Constantinos Chrysostomou; Joan Sanchez De Toledo; Tracy Avolio; Maria V Motoa; Donald Berry; Victor O Morell; Richard Orr; Ricardo Munoz |
Related Documents
:
|
15857526 - Pressure support ventilation combined with volume guarantee versus synchronized intermi... 15523126 - Benefits of non invasive ventilation. 9279186 - Use of methohexital for elective intubation in neonates. 23365126 - Breast-feeding vs formula-feeding for infants born small-for-gestational-age: divergent... 1097616 - A reappraisal of the value of the igm fluorescent treponemal antibody absorption test i... 15174776 - Positive pressure ventilation at neonatal resuscitation: review of equipment and intern... |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Volume: 10 ISSN: 1529-7535 ISO Abbreviation: Pediatr Crit Care Med Publication Date: 2009 Nov |
Date Detail:
|
Created Date: 2009-11-09 Completed Date: 2010-01-26 Revised Date: 2012-06-18 |
Medline Journal Info:
|
Nlm Unique ID: 100954653 Medline TA: Pediatr Crit Care Med Country: United States |
Other Details:
|
Languages: eng Pagination: 654-60 Citation Subset: IM |
Affiliation:
|
Department of Pediatrics and Critical Care Medicine, Division of Cardiac Intensive Care, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA. chrycx@chp.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Age Factors Analgesics, Non-Narcotic / administration & dosage, adverse effects, pharmacology, therapeutic use* Analgesics, Opioid / administration & dosage Dexmedetomidine / administration & dosage, adverse effects, pharmacology, therapeutic use* Dose-Response Relationship, Drug Drug Therapy, Combination Drug Toxicity Female Fentanyl / administration & dosage Heart Defects, Congenital / surgery* Hemodynamics / drug effects Humans Hypnotics and Sedatives / administration & dosage, adverse effects, pharmacology, therapeutic use* Infant Infant, Newborn Infusions, Intravenous Intensive Care Units, Pediatric Intubation, Intratracheal Male Pain, Postoperative / prevention & control* Respiration / drug effects Retrospective Studies |
| Chemical | |
Reg. No./Substance:
|
0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid; 0/Hypnotics and Sedatives; 113775-47-6/Dexmedetomidine; 437-38-7/Fentanyl |
| Comments/Corrections | |
Comment In:
|
Pediatr Crit Care Med. 2010 Sep;11(5):645-6; author reply 646
[PMID:
20823746
]
|
Erratum In:
|
Pediatr Crit Care Med. 2012 May;13(3):373 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Early inhibition of prostaglandin synthesis by n-3 fatty acids determinates histologic severity of n...
Next Document: Kaposi's sarcoma in the pediatric population: the critical need for a tissue diagnosis.