title: Intraoperative dexmedetomidine reduces postoperative mechanical ventilation in infants after open heart surgery.
abstract: OBJECTIVE
  The inclusion of dexmedetomidine in the operative and postoperative management of infants with congenital heart defects has lessened the need for opioids that may cause respiratory depression. Our objective was to show that a dexmedetomidine bolus at or about the time of sternal closure is associated with a decrease in the use of mechanical ventilation in the immediate postoperative period.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Single pediatric tertiary cardiac center.
  
  
  METHODS
  Infants undergoing surgical intervention for congenital heart defects requiring cardiopulmonary bypass, age 30-365 days in a 5-year time period from June 1, 2008, to December 31, 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of 1,057 total encounters, 441 met inclusion criteria and were evenly distributed over the 5-year time period. Dexmedetomidine had been given at or about the time of sternal closure in 57% of patients. When the exposed and unexposed groups were compared in terms of mechanical ventilation immediately postoperative, there was a statistically significant effect of using dexmedetomidine on the odds of receiving mechanical ventilation (p = 0.0019). This difference remained significant after adjusting for covariates affecting the decision for mechanical ventilation, including year of the procedure, age and weight of subject, cardiopulmonary bypass time, the use of deep hypothermic circulatory arrest, intraoperative fentanyl dose, and the Risk Adjustment for Congenital Heart Surgery Score 1 (p = 0.0317). The odds of receiving mechanical ventilation are estimated to be two times higher for patients who did not receive dexmedetomidine than for patients who received dexmedetomidine after adjusting for variables.
  
  
  CONCLUSIONS
  The use of dexmedetomidine bolus in the operating room at the time of sternal closure in infants undergoing open heart surgery is associated with reduced need for mechanical ventilation in the immediate postoperative period.
authors.affiliation: 1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 3Biostatistics and Data Management Core, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Barbara-Jo
authors.initials: BJ
authors.lastname: Achuff
authors.forename: Susan C
authors.initials: SC
authors.lastname: Nicolson
authors.forename: Okan U
authors.initials: OU
authors.lastname: Elci
authors.forename: Athena F
authors.initials: AF
authors.lastname: Zuppa
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011182:Postoperative Care / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D020927:Dexmedetomidine