title: Dexmedetomidine use in a pediatric cardiac intensive care unit: can we use it in infants after cardiac surgery?
abstract: OBJECTIVE
  To assess clinical response of dexmedetomidine alone or in combination with conventional sedatives/analgesics after cardiac surgery.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Pediatric cardiac intensive care unit.
  
  
  METHODS
  Infants and neonates after cardiac surgery.
  
  
  RESULTS
  We identified 80 patients including 14 neonates, at mean age and weight of 4.1 +/- 3.1 months and 5.5 +/- 2 kg, respectively, who received dexmedetomidine for 25 +/- 13 hours at an average dose of 0.66 +/- 0.26 microgxkgxhr. Overall normal sleep to moderate sedation was documented 94% of the time and no pain to mild pain for 90%. Systolic blood pressure (SBP) decreased from 89 +/- 15 mm Hg to 85 +/- 11 mm Hg (p = .05), heart rate (HR) from 149 +/- 22 bpm to 129 +/- 16 bpm (p < .001), and respiratory rate (RR) remained unchanged. When baseline arterial blood gases were compared with the most abnormal values, pH decreased from 7.4 +/- 0.07 to 7.37 +/- 0.05 (p = .006), Po2 from 91 +/- 67 mm Hg to 66 +/- 29 mm Hg (p = .005), and CO2 increased from 45 +/- 8 mm Hg to 50 +/- 12 mm Hg (p = .001). At the beginning of the study, 37 patients (46%) were mechanically ventilated; and at 48 hours, 13 patients (16%) were still intubated and five patients failed extubation. Three groups of patients were identified: A, dexmedetomidine only (n = 20); B, dexmedetomidine with sedatives/analgesics (n = 38); and C, dexmedetomidine with both sedatives/analgesics and fentanyl infusion (n = 22). The doses of dexmedetomidine and rescue sedatives/analgesics were not significantly different among the three groups but duration of dexmedetomidine was longer in group C vs. A (p = .03) and C vs. B (p = .002). Pain, sedation, SBP, RR, and arterial blood gases were similar. HR was higher in group C vs. B (p = .01). Comparison between neonates and infants showed that infants required higher dexmedetomidine doses, 0.69 +/- 25 microgxkgxhr, and vs. 0.47 +/- 21 microgxkgxhr (p = .003) and had lower HR (p = .01), and RR (p = .009), and higher SBP (p < .001).
  
  
  CONCLUSIONS
  Dexmedetomidine use in infants and neonates after cardiac surgery was well tolerated in both intubated and nonintubated patients. It provides an adequate level of sedation/analgesia either alone or in combination with low-dose conventional agents.
authors.affiliation: Department of Pediatrics and Critical Care Medicine, Division of Cardiac Intensive Care, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA. chrycx@chp.edu
authors.forename: Constantinos
authors.initials: C
authors.lastname: Chrysostomou
authors.forename: Joan
authors.initials: J
authors.lastname: Sanchez De Toledo
authors.forename: Tracy
authors.initials: T
authors.lastname: Avolio
authors.forename: Maria V
authors.initials: MV
authors.lastname: Motoa
authors.forename: Donald
authors.initials: D
authors.lastname: Berry
authors.forename: Victor O
authors.initials: VO
authors.lastname: Morell
authors.forename: Richard
authors.initials: R
authors.lastname: Orr
authors.forename: Ricardo
authors.initials: R
authors.lastname: Munoz
mesh_terms: D000367:Age Factors; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control*; D012119:Respiration / Q000187:drug effects; D012189:Retrospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D005283:Fentanyl