Role of dexmedetomidine as a perioperative sedative and analgesic for noncyanotic pediatric cardiac patients

Purpose In this report, we highlight the effectiveness and safety of dexmedetomidine (DEX), a selective a2-agonist, as a perioperative sedative and analgesic for pediatric noncyanotic cardiac patients scheduled for elective open heart surgery. Patients and methods Thirty patients aged 6–12 years scheduled for cardiac surgery with a cardiopulmonary bypass were divided randomly into two groups: the DEX group received a DEX infusion at 0.5 mg/kg/h and the midazolam (MDZ) group received a MDZ infusion at 0.2 mg/kg/min before induction of anesthesia to be continued throughout the operation; the dose of the infused drugs was reduced to half by the end of cardiopulmonary bypass and to be discontinued with the last skin suture. Anesthesia was maintained using isoflurane 0.5%. Results The heart rate (HR) levels were significantly higher in the MDZ group compared with the DEX group during surgery. The mean arterial pressure was significantly higher in the MDZ group during the induction of anesthesia and at time of sternotomy only. The dose of additional fentanyl required during the operation as well as the pain score during cannulation were significantly higher in the MDZ group. Respiratory rate was significantly higher in the MDZ group during induction of anesthesia. In terms of the variables in ICU, HR was significantly lower in the DEX group at the time of periextubation. Additional fentanyl until the time of extubation and the pain score were significantly lower in the DEX group. Conclusion Our data indicate that DEX is a well-tolerated and effective agent that provides an adequate level of perioperative sedation and analgesia in congenital cardiac surgery for noncyanotic pediatric patients.