Perioperative Use of Dexmedetomidine Is Associated With Decreased Incidence of Ventricular and Supraventricular Tachyarrhythmias After Congenital Cardiac Operations

Abstract

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.

Effect of Anesthesia on the Developing Brain: Infant and Fetus

“…It is utilized for postoperative sedation, as a component of total intravenous anesthesia regimens, for opioid-sparing in tonsillectomy, and also for premedication, procedural sedation, prevention of postoperative emergence agitation, and as a component of a balanced general anesthetic technique [33] . Among dexmedetomidine's desirable properties are its ability to maintain normal respiratory patterns, reduce the incidence of postcardiac surgical tachydysrhythmias [34] , and reduce doses of volatile anesthetic agents and opioids when utilized as a component of a balanced anesthetic technique [33] . Dexmedetomidine has a significant body of research and clinical publication in children; a recent PubMed search revealed over 500 publications in children 0-18 years, and 200 in children birth to 2 years of age.…”

Dexmedetomidine controls junctional ectopic tachycardia during Tetralogy of Fallot repair in an infant

“…Previous data support the potential use of dexmedetomidine as a therapeutic agent to treat perioperative arrhythmias in the pediatric population [ Table 1]. [15][16][17][18][19] Chrysostomou et al were the first to suggest the potential therapeutic role of dexmedetomidine in their retrospective review of the use of dexmedetomidine to treat 14 pediatric patients with tachyarrhythmias. [15] Dexmedetomidine was used as a primary drug in nine patients and as a rescue drug in five others when primary treatment had failed (amiodarone or amiodarone and hypothermia).…”

“…[17] Dexmedetomidine was started after the induction of anesthesia, continued intraoperatively and postoperatively for 38 ± 4 h at an average dose of 0.76 ± 0.04 µg/kg/h. Sustained postoperative arrhythmias occurred in 10 control patients compared with two patients who received dexmedetomidine (P = 0.001).…”

Dexmedetomidine in pediatric cardiac anesthesia

“…[8,9] No adverse effects on the pulmonary vasculature have been reported dexmedetomidine. [13,14] In a few anecdotal reports dexmedetomidine was successful in restoring SR in situations where routine antiarrhythmic agents had failed. [15][16][17] These reports clearly indicate that dexmedetomidine has antiarrhythmic actions.…”