Effect of Dexmedetomidine Infusion on Hemodynamics and Stress Responses in Pediatric Cardiac Surgery: A Randomized Trial

Infants and children compared with adults have intensified stress responses that lead to increased morbidity and mortality. Stress control reduces the incidence of complications and improves recovery. In clinical and experimental studies, dexmedetomidine reduces the inflammatory and neuroendocrine responses. This prospective randomized double-blinded clinical trial was conducted to assess the role of dexmedetomidine in reducing stress responses. According to convenient sampling method, 40 patients in two groups (case under treatment with dexmedetomidine and control, each including 20 patients) were selected from whom admitted for open heart surgery. Anesthesia was induced and maintained by fentanyl and midazolam. After central venous and arterial catheter insertion, patients were randomly allocated into one of two equal groups (n = 20 each). In the dexmedetomidine group, patients received an initial loading dose (0.5 μg/kg) during 10 minutes immediately followed by a continuous infusion of 0.5 μg/kg. In the control group, normal saline solution with similar volume was infused. Changes in heart rate, systolic and diastolic blood pressures and central venous pressure before administration of dexmedetomidine, in 10, 20 and 30 minutes after the operation, after skin incision, after sternotomy, after separation from the pump and at the end of procedure showed no significant difference between the two groups (P = 0.860, 0.067, 0.888 and 0.482, respectively). Changes in lactate, interleukin 6, tumor necrosis factor, C-reactive protein concentrations before administration of dexmedetomidine, after separation of pump and 24 hours after intensive care unit entrance showed no significant difference between the two groups (P = 0.525, 0.767, 0.868 and 0.840, respectively). According to our findings, using dexmedetomidine as an adjuvant anesthetic medication with initial loading dose of 0.5 μg/kg and maintenance dose of 0.5 μg /kg in pediatric heart surgeries is a safe choice. However, further studies are needed to clarify the role of dexmedetomidine to reduce stress responses.