This preliminary, observational report suggests that dexmedetomidine may have a potential therapeutic role in the acute phase of perioperative atrial and junctional tachyarrhythmias for either HR control or conversion to NSR.

Background Postoperative tachyarrhythmias remain a common complication after congenital cardiac surgery. A recent case-series has shown that dexmedetomidine, an alpha-2 adrenoreceptor agonist can have a therapeutic role in supraventricular tachyarrhythmias for either cardioversion to sinus rhythm or heart rate control. The present study was performed to determine if routine perioperative use of dexmedetomidine can decrease the incidence of supraventricular and ventricular tachyarrhythmias. Methods Prospective cohort study of pediatric patients undergoing cardiothoracic surgery. Thirty-two patients who were initiated on dexmedetomidine infusion (DEX-group) before surgery were compared with 20 patients who did not receive dexmedetomidine (control-group). Results Dexmedetomidine was started after anesthesia induction and continued through surgery and postoperative period for 38±4 hours at a mean dose of 0.76 ±0.04 mcg/kg/hr. Ten patients in control-group and 2 in DEX-group (p=0.001) had a total of 16 episodes of tachyarrhythmias. The incidence of ventricular tachycardia was 25% vs.0% (p=0.01) and of supraventricular arrhythmias 25% vs. 6% (p=0.05) in the control and DEX-group respectively. Two patients in the control-group and 1 in the Dex-group had transient complete heart block. Control-group had a higher heart rate 141 ± 5 vs.127 ±3 bpm (p=0.03), more sinus tachycardia episodes 40% vs. 6% (p=0.008), required more antihypertensives with nitroprusside 20 ± 7 vs.4 ± 1 mcg/kg (p=0.004) and nicardipine 13 ± 5 vs.2 ± 1 mcg/kg (p=0.02) and required more fentanyl 39 ± 8 vs.19 ± 3 mcg/kg (p=0.005). Conclusions Perioperative use of dexmedetomidine is associated with significantly decreased incidence of ventricular and supraventricular tachyarrhythmias without significant adverse effects.

Chest ultrasound performed by cardiac intensivists allows for an early and accurate diagnosis of abnormal diaphragmatic motion, as evidenced by their ability to predict fluoroscopy findings in pediatric cardiothoracic patients. Training in ultrasound-guided assessment of diaphragmatic motion should be reinforced during pediatric cardiac intensive care fellowship.