title: Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta-analysis.
abstract: BACKGROUND
  Dexmedetomidine decreases cardiac complications in adults undergoing cardiovascular surgery. This systematic review assessed whether perioperative dexmedetomidine improves congenital heart disease (CHD) surgery outcomes in children.
  
  
  METHODS
  The PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) or observational studies that were published until 16 April 2015 and compared dexmedetomidine with placebo or an alternative anesthetic agent during pediatric CHD surgery. The assessed outcomes included hemodynamics, ventilation length, intensive care unit (ICU) and hospital stays, blood glucose and serum cortisol levels, postoperative analgesia requirements, and postoperative delirium.
  
  
  RESULTS
  Five RCTs and nine observational studies involving 2229 patients were included. In pooled analyses, dexmedetomidine was associated with shorter length of mechanical ventilation (mean difference: -93.36, 95% CI: -137.45, -49.27), lower postoperative fentanyl (mean difference: -24.11, 95% CI: -36.98, -11.24) and morphine (mean difference: -0.07, 95% CI: -0.14, 0.00) requirements, reduced stress response (i.e., lower blood glucose and serum cortisol levels), and lower risk of delirium (OR: 0.39, 95% CI: 0.21, 0.74). The hemodynamics of dexmedetomidine-treated patients appeared more stable, but there were no significant differences in the ICU or hospital stay durations. Dexmedetomidine may increase the bradycardia and hypotension risk (OR: 3.14, 95% CI: 1.47, 6.69).
  
  
  CONCLUSIONS
  Current evidence indicates that dexmedetomidine improves outcomes in children undergoing CHD surgery. However, this finding largely relies on data from observational studies; high-quality RCTs are warranted because of the potential for subject selection bias.
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Wanying
authors.initials: W
authors.lastname: Pan
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yueting
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Ge
authors.initials: G
authors.lastname: Zhou
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Hua
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Liqiu
authors.initials: L
authors.lastname: Mo
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D003693:Delirium; D020927:Dexmedetomidine; D006330:Heart Defects, Congenital / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D006993:Hypnotics and Sedatives; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D006854:Hydrocortisone
keywords: congenital heart disease; dexmedetomidine; meta-analysis; pediatric