Excessive postoperative bleeding in neonates after CPB is independently associated with increased adverse events, specifically the need for postoperative dialysis and ECMO support. Our findings in neonates are congruent with other recent research that also has found increasing transfusion requirements after pediatric CPB to be independently associated with an increase in major postoperative adverse events. Our results may aid clinicians in anticipating potential adverse events after neonatal bypass and in allocating the resources necessary to manage these events.

T he effects of dexmedetomidine premedication on the minimum alveolar concentration of sevoflurane for tracheal intubation (MAC TI ) in children was investigated in a prospective, randomized, clinical comparison study in the operating room of an academic hospital in 90 pediatric, American Society of Anesthesiologists physical status I patients, aged 3 to 7 years. The patients, who were scheduled for minor surgery, were randomized into 3 groups who received placebo, dexmedetomidine 1 μg/kg or dexmedetomidine 2 μg/kg approximately 60 minutes before anesthesia. Anesthesia was induced with sevoflurane. Each concentration of sevoflurane for which a tracheal intubation was attempted was predetermined based on modification of the Dixon's up-and-down method, with 0.25% as a step size and held constant for at least 15 minutes before tracheal intubation. All responses ("movement" or "no movement") to tracheal intubation were evaluated. The MAC TI (mean ± SD) values of sevoflurane were 2.82% ± 0.17% in the control group, 2.26% ± 0.18% in the 1 μg/kg dexmedetomidine group, and 1.83% ± 0.16% in the 2 μg/kg dexmedetomidine group. Dexmedetomidine premedication (1 and 2 μg/kg) decreased the MAC TI by 20% and 35%, respectively. No clinically important episodes of hypotension or bradycardia occurred in any patient. Intranasal dexmedetomidine premedication results in a dose-dependent decrease in the concentration of sevoflurane required for tracheal intubation of children. COMMENTThis article by Yao et al examines the effects of intranasal dexmedetomidine premedication on tracheal intubation conditions during standard state sevoflurane anesthesia. Ninety pediatric patients aged 3 to 7 years were randomized into 3 groups (placebo, 1 μg/kg, and 2 μg/kg) intranasal dexmedetomidine or placebo administered 60 minutes before inhalation induction. After inhalational induction, the end-tidal sevoflurane concentration was held constant for 15 minutes to allow for adequate equilibrium with the brain concentration. The minimal alveolar concentration of sevoflurane for tracheal intubation (MAC TI ) was calculated using Dixon's up-and-down method and found to be 2.82% for placebo, 2.26% for 1 μg/kg dexmedetomidine, and 1.83% for 2 μg/kg dexmedetomidine, showing that intranasal dexmedetomidine reduces the minimum alveolar concentration in a dose-dependent manner by 20% and 35%, respectively.Although this is the first report about the effects of intranasal dexmedetomidine on MAC TI , the study results are consistent with previous investigations showing that the α-2 agonist clonidine reduces anesthetic requirements.N eonates undergoing congenital cardiac surgery requiring cardiopulmonary bypass (CPB) are at a high risk of postoperative bleeding for reasons including immature coagulation, long CPB times, hemodilution from the CPB circuit priming volumes, and cardiac repairs performed at low temperatures. There is also increased morbidity associated with blood transfusions that are commonly used to treat postoperative bleeding. This study observed t...