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Dexmedetomidine improves the outcomes in paediatric cardiac surgery: a meta-analysis of randomized controlled trials

Yang Liu1, Weishuai Bian1, Ping Liu1

  • 1Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.

Interactive Cardiovascular and Thoracic Surgery
|March 10, 2018
PubMed

Insights

Dexmedetomidine administration in pediatric cardiac surgery significantly reduces mechanical ventilation duration, intensive care unit, and hospital length of stay. It also lowers junctional ectopic tachycardia incidence, though postoperative deaths were unaffected.

Area of Science:

  • Pediatric Cardiac Surgery
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Dexmedetomidine is known to decrease cardiac complications in adults undergoing cardiac surgery.
  • Clinical trial results on dexmedetomidine's effects on pediatric cardiac surgery outcomes are conflicting.

Purpose of the Study:

  • To evaluate the efficacy of dexmedetomidine in improving outcomes for pediatric patients undergoing cardiac surgery.
  • To analyze its impact on mechanical ventilation duration, intensive care unit (ICU) and hospital length of stay (LOS), and the incidence of junctional ectopic tachycardia and postoperative deaths.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
  • Searched EMBASE, PubMed, and Cochrane CENTRAL for studies comparing dexmedetomidine with placebo or other anesthetics in pediatric cardiac surgery patients.
  • Primary outcome: duration of mechanical ventilation. Secondary outcomes: ICU LOS, hospital LOS, junctional ectopic tachycardia, and postoperative deaths.

Main Results:

  • Nine trials involving 837 patients were analyzed.
  • Dexmedetomidine significantly reduced mechanical ventilation duration (WMD -2.20 hours), ICU LOS (WMD -0.47 days), and hospital LOS (WMD -1.80 days).
  • A significant reduction in postoperative junctional ectopic tachycardia was observed (RR 0.40), with no significant difference in postoperative deaths.

Conclusions:

  • Perioperative dexmedetomidine may shorten mechanical ventilation and LOS in pediatric cardiac surgery patients.
  • It may also decrease the incidence of junctional ectopic tachycardia.
  • Further high-quality RCTs are recommended to confirm these benefits before widespread clinical application in pediatric congenital heart disease surgery.
Abstract

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