Dexmedetomidine in combination with midazolam after pediatric cardiac surgery.
OBJECTIVE
Although midazolam is one of the most commonly used sedatives for infants in the intensive care unit, it has well-known disadvantages including a dose-dependent potential to induce tolerance, withdrawal, and hemodynamic depression. The aim of this study was to evaluate the clinical effects of dexmedetomidine combined with midazolam in postoperative intensive care following pediatric cardiac surgery.


METHODS
Forty consecutive infants who underwent cardiac surgery for isolated ventricular septal defects from January 2011 to July 2013 were enrolled in this retrospective study. They were divided into two groups according to postoperative sedation regimen: dexmedetomidine sedation with midazolam (n = 20), or midazolam sedation without dexmedetomidine (control group, n = 20). Perioperative variables were compared between the two groups.


RESULTS
There were no significant differences in patient characteristics between the two groups. During the first 24 h after intensive care unit admission, heart rate and serum lactate levels were significantly lower in the dexmedetomidine group compared to the control group (p = 0.0292 and p = 0.0027, respectively). The maximal midazolam dose was also significantly lower in the dexmedetomidine group (0.12 ± 0.09 vs. 0.20 ± 0.08 mg kg(-1) h(-1), p = 0.0059). There were no adverse effects of dexmedetomidine such as bradycardia, hypotension, agitation, or seizures. Three (15%) patients in the control group and none in the dexmedetomidine group experienced sudden cardiopulmonary decompensation.


CONCLUSIONS
Dexmedetomidine can provide favorable sedative properties with a reduced requirement for concomitant midazolam and stable hemodynamics with tachycardia prevention, for postoperative intensive care following pediatric cardiac surgery.
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan tohasegawa_kch@hp.pref.hyogo.jp.
Tomomi
T
Hasegawa
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
Yoshihiro
Y
Oshima
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
Ayako
A
Maruo
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
Hironori
H
Matsuhisa
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
Akiko
A
Tanaka
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
Rei
R
Noda
Department of Cardiovascular Surgery, Kobe Children's Hospital, Hyogo, Japan.
Shunsuke
S
Matsushima
D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D007564:Japan; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D008874:Midazolam
Cardiac surgical procedures; Child; Dexmedetomidine; Intensive care units; Midazolam; Tachycardia; pediatric