title: 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 operations. Dexmedetomidine (DEX), an α-2 adrenoreceptor agonist, can have a therapeutic role in supraventricular tachyarrhythmias for cardioversion to sinus rhythm or heart rate control. Whether routine perioperative use of DEX decreases the incidence of supraventricular and ventricular tachyarrhythmias was studied.
  
  
  METHODS
  In this prospective cohort study, 32 pediatric patients undergoing cardiothoracic operations received DEX and were compared with 20 control patients who did not receive DEX.
  
  
  RESULTS
  Dexmedetomidine was started after anesthesia induction and continued intraoperatively and postoperatively for 38±4 hours (mean dose, 0.76±0.04 μg/kg/h). Ten control patients and 2 DEX patients sustained 16 episodes of tachyarrhythmias (p=0.001), including a 25% vs 0% (p=0.01) incidence of ventricular tachycardia and 25% vs 6% (p=0.05) of supraventricular arrhythmias in the control and DEX group, respectively. Transient complete heart block occurred in 2 control patients and in 1 DEX patient. Control patients had a higher heart rate (141±5 vs 127±3 beats/min, p=0.03), more sinus tachycardia episodes (40% vs 6%; p=0.008), required more antihypertensive drugs with nitroprusside (20±7 vs 4±1 μg/kg; p=0.004) and nicardipine (13±5 vs 2±1 μg/kg; p=0.02), and required more fentanyl (39±8 vs 19±3 μg/kg; p=0.005).
  
  
  CONCLUSIONS
  Perioperative use of dexmedetomidine is associated with a significantly decreased incidence of ventricular and supraventricular tachyarrhythmias, without significant adverse effects.
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15224, 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: Peter
authors.initials: P
authors.lastname: Wearden
authors.forename: Edmund H
authors.initials: EH
authors.lastname: Jooste
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lichtenstein
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Callahan
authors.forename: Tunga
authors.initials: T
authors.lastname: Suresh
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Malley
authors.forename: Dana
authors.initials: D
authors.lastname: Shiderly
authors.forename: Jamie
authors.initials: J
authors.lastname: Haney
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Richard
authors.initials: R
authors.lastname: Orr
authors.forename: Ricardo
authors.initials: R
authors.lastname: Munoz
authors.forename: Victor O
authors.initials: VO
authors.lastname: Morell
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020927:Dexmedetomidine