Key result
Dexmedetomidine sedation in 9 pediatric post-Fontan patients prevented postoperative increases in arterial carbon dioxide compared to 5 controls, but caused bradycardia requiring pacing.
Why the study?
Does dexmedetomidine sedation prevent respiratory depression and subsequent increases in pulmonary vascular resistance in pediatric patients post-Fontan surgery compared to standard sedation?
Cohort (n=14)
No
Does dexmedetomidine sedation prevent respiratory depression and subsequent increases in pulmonary vascular resistance in pediatric patients post-Fontan surgery compared to standard sedation?
Dexmedetomidine sedation in pediatric post-Fontan patients may prevent respiratory depression and rises in pulmonary vascular resistance, but is associated with a significant risk of bradycardia requiring pacing.
Answers are grounded in this paper and cite their sources.
May avoid hypercarbia but risks pacing-requiring bradycardia post-Fontan; leaves open net benefit in larger trials.
OBJECTIVE: The hemodynamic, respiratory, and sedative effects of dexmedetomidine (DEX) for pediatric patients post-Fontan surgery. DESIGN: Retrospective. SETTING: Single institutional intensive care unit. PARTICIPANTS: Fourteen patients undergoing Fontan-type surgery. RESULT: A retrospective review was conducted on 14 pediatric patients who had undergone a Fontan procedure for congenital heart disease. A vital component of postoperative management of these patients is to prevent an increase in pulmonary vascular resistance (PVR) that may lead to a serious reduction in cardiac output. DEX an alpha-2 adrenergic receptor agonist might offer an advantage over current sedation methods in preventing a rise in PVR. Nine patients received sedation with DEX and five patients in a control group were administered standard regimens of sedation and analgesia. The DEX group exhibited no evidence of an increased partial pressure of arterial carbon dioxide postoperatively as opposed to the control group. This lack of respiratory depression made the DEX group less likely to increase their PVR. However, the DEX group did experience a significant incidence of bradycardia that required the use of a cardiac pacemaker. CONCLUSIONS: The results of this retrospective review of the role of DEX in the management of the post-Fontan surgical pediatric patient indicate some potential advantages.
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Tokuhira et al. (2009) conducted a cohort in Congenital heart disease post-Fontan procedure (n=14). Dexmedetomidine vs. Standard regimens of sedation and analgesia was evaluated on Partial pressure of arterial carbon dioxide and incidence of bradycardia. Dexmedetomidine sedation in 9 pediatric post-Fontan patients prevented postoperative increases in arterial carbon dioxide compared to 5 controls, but caused bradycardia requiring pacing.
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