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Effectiveness of Dexmedetomidine as Myocardial Protector in Children With Classic Tetralogy of Fallot Having
Dian Kesumarini1, Yunita Widyastuti2, Cindy Elfira Boom1
1Department of Anesthesia and Intensive Therapy, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Insights
Dexmedetomidine (DEX) effectively protected the hearts of Indonesian children undergoing tetralogy of Fallot (TOF) repair surgery. This cardioprotective agent reduced key biomarkers and improved cardiac function post-cardiopulmonary bypass (CPB).
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Pharmacology
Background:
- Tetralogy of Fallot (TOF) repair involves cardiopulmonary bypass (CPB), a procedure that can induce myocardial injury.
- Identifying effective cardioprotective agents is crucial for improving outcomes in pediatric cardiac surgery.
Purpose of the Study:
- To evaluate the efficacy of dexmedetomidine (DEX) as a cardioprotective agent in Indonesian children undergoing classic TOF repair with CPB.
- To assess the impact of DEX on myocardial injury markers, inflammatory response, and hemodynamic parameters during and after CPB.
Main Methods:
- A prospective, double-blinded, randomized controlled trial was conducted with 66 children undergoing classic TOF repair.
- Patients received either dexmedetomidine (DEX) added to the CPB priming solution or a normal saline placebo.
- Biomarkers (Troponin I, interleukin-6, lactate) and hemodynamic parameters were monitored up to 30 days post-surgery.
Main Results:
- Dexmedetomidine significantly reduced Troponin I, interleukin-6, and lactate levels at various time points after CPB compared to placebo.
- DEX administration led to increased cardiac output and index, while decreasing systemic vascular resistance.
- The vasoactive inotropic score was reduced in the DEX group, but there were no significant differences in ventilation duration, ICU stay, or mortality.
Conclusions:
- Dexmedetomidine serves as an effective cardioprotective agent in pediatric patients undergoing tetralogy of Fallot repair with cardiopulmonary bypass.
- DEX demonstrates beneficial effects on myocardial injury markers and hemodynamics without increasing adverse outcomes.
- Postoperative mortality rates were comparable between the dexmedetomidine and placebo groups.
Objectives:
Efficacy of dexmedetomidine (DEX) as a cardioprotective agent in Indonesian children undergoing classic tetralogy of Fallot (TOF) repair with cardiopulmonary bypass (CPB).
Design:
A prospective, parallel trial using block randomization along with double-blinded preparation of treatment agents by other parties.
Setting:
National Cardiovascular Center Harapan Kita, Indonesia.
Participants:
Sixty-six children with classic TOF scheduled for corrective surgery. No children were excluded. All patients had fulfilled the criteria for analysis.
Interventions:
A total of 0.5 µg/kg bolus of DEX was added to the CPB priming solution, followed by 0.25 µg/kg/h maintenance during bypass. The placebo group used normal saline. Follow-ups were up to 30 days.
Measurements And Main Results:
Troponin I was lower in the DEX group at 6 hours (30.48 ± 19.33 v 42.73 ± 27.16, p = 0.039) and 24 hours after CPB (8.89 ± 5.42 v 14.04 ± 11.17, p = 0.02). Within a similar timeframe, DEX successfully lowered interleukin-6 (p = 0.03; p = 0.035, respectively). Lactate was lower in the Dex group at 1, 6, and 24 hours after CPB (p < 0.01; p = 0.048; p = 0.035; respectively). Dexmedetomidine increased cardiac output and index from 6 hours after bypass, but vice versa in systemic vascular resistance. Reduction of vasoactive inotropic score was seen during intensive care unit monitoring in the Dex group (p = 0.049). Nevertheless, DEX did not significantly affect the length of ventilation (p = 0.313), intensive care unit stay (p = 0.087), and mortality (p > 0.99).
Conclusions:
Dexmedetomidine during CPB is an effective cardioprotective agent in TOF children having surgery. Postoperative mortality was comparable across groups.
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