Administration of dexmedetomidine alone during diagnostic cardiac catheterization in adults with congenital heart disease: two case reports

Abstract

We report the clinical management of 2 adults with mental retardation because of trisomy 21 who were sedated with high-dose dexmedetomidine (DEX) alone during diagnostic cardiac catheterization (DCC). The first patient was a 25-year-old man with aortic regurgitation and ventricular septal defect. DEX increased his Ramsay sedation score; however, a high dose and bolus injection of DEX were required to perform an invasive procedure. Cardiovascular drugs were not administered and heart rate was maintained in the low 40s. The maximum predicted plasma concentration (pCp) of DEX was 2.3 ng/mL. The second patient was a 26-year-old woman who had developed hypoxia 20 years after palliative surgery for tetralogy of Fallot. High-dose DEX was administered to keep the bispectral index value below 70 and maintain an immobile state; her maximum pCp of DEX was 4.3 ng/mL. Percutaneous oxygen saturation was kept above 83%, because of the suspicion that DEX may increase the ratio of pulmonary artery flow to systemic artery flow. In both cases, no respiratory system complications occurred despite inspiration of room air, indicating the usefulness of DEX for DCC. However, because of DEX may affect DCC data, it is necessary to pay careful attention to the use of DEX during DCC.

A high dose of dexmedetomidine using the BIS monitor™ for diagnostic and interventional cardiac catheterization in a toddler with congenital heart disease

“…The mean pCp of DEX during the procedure was calculated to be 4.1 ng/mL. This value is higher than the value in previous case studies in which a high dose of DEX was used for sedation for an invasive procedure in adult patients [7,8]. The reason for this may be the difference in sensitivity between adults and children, accuracy of simulation, or difference in the degree of invasiveness of the procedure.…”

“…This finding suggests that the stimuli were as large as MRI. We also found a case in which a high dose of DEX was used for DICC in a pediatric patient similar to MRI in pediatric patients or DCC in adult patients [6,8]. The mean pCp of DEX during the procedure was calculated to be 4.1 ng/mL.…”

“…The fact that the assessment could be performed under spontaneous breathing in room air was one of the merits of this method. However, if DCC was being used for another purpose, for example measurement of cardiac output, vascular resistance, and Q p /Q s (ratio of pulmonary to systemic blood flow), then indication for DEX must be given due consideration [8]. If the catheterization is used for intervention, then great care need not be taken regarding the effect of DEX on the hemodynamics.…”

“…A high dose of DEX is used for sedating many pediatric patients undergoing MRI [5,6]. We thought that DEX could provide desirable sedation for DCC in a pediatric patient if a higher dose of DEX than the standard dose based on the package insert (initial dose 1 lg/kg over 10 min; maintenance dose 0.2-0.7 lg/kg/h) was used, as is the case for MRI sedation in pediatric patients or sedation of adult patients for invasive procedures [6][7][8]. We administered DEX and adjusted the dose of DEX according to the bispectral index (BIS) value and brain activity waveform obtained by use of a BIS monitor TM (Aspect, BIS Monitor A-2000; Nihon Kohden, Tokyo, Japan) to perform diagnostic and interventional cardiac catheterization (DICC) in a toddler; therefore, a high dose of DEX had to be administered.…”

Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

“…Dexmedetomidine (DEX) has been used in cases where evaluation or treatment needs to be performed using approaches such as gastrointestinal endoscopy 21 or cardiac catheterization, 22 because of its sedative effects and general safety owing to its extremely low potential for respiratory depression. DEX is a strong and highly selective α2 adrenergic agent that has various pharmacologic actions.…”