Outcomes of a Dexmedetomidine Infusion Protocol in Pediatric Patients Post-Cardiac Catheterization: A Program...

The purpose of this project was to evaluate a recently implemented postoperative dexmedetomidine infusion protocol for required prolonged bedrest in a pediatric cardiac catheterization laboratory post-anesthesia care unit (PACU).

This project utilized program evaluation methodology, including a baseline needs assessment, clinician interviews, and retrospective cohort analysis.

Following the formal protocol implementation in March 2024, we allowed a 6-month integration period before conducting a retrospective chart review of a 3-month convenience sample (October 1-December 31, 2024). Data collected included patient demographics, rebleeding incidence, agitation and pain scores, rescue medication use, and PACU length of stay (LOS). Eligible records included patients under 21 years of age who underwent cardiac catheterization with femoral access and recovered in the PACU. Exclusion criteria were non-cardiac catheterization procedures, non-femoral access, or direct admission to the intensive care unit (ICU). Additionally, a supplemental analysis of all rebleeding events from March 1, 2024 to March 30, 2025 was performed to better characterize these occurrences. SPSS v29.0 was used for descriptive statistics and significance testing, with α = 0.05.

Sixty-five pediatric patients met inclusion criteria for the 3-month convenience sample, with a mean age of 6.1 years and mean weight of 25.4 kg. Most patients (89.2%) received general anesthesia, and 30 (46.1%) received the dexmedetomidine infusion protocol in the PACU. Within this 3-month cohort, the incidence of rebleeding was low (n = 2). Across the extended analysis period (March 1, 2024, to March 30, 2025), 13 patients experienced a rebleeding event; these patients had a higher mean age (9.7 years), and most (69.2%) did not receive a dexmedetomidine infusion. In the primary post-protocol sample, patients who did not receive dexmedetomidine infusions exhibited significantly higher agitation scores at multiple time points (p <.05). Pain scores were similar across groups at all measured intervals (p =.427 to.897). Rescue medication use was significantly higher among patients who did not receive the dexmedetomidine infusion (χ²(6, N = 65) = 34.94, p <.001). PACU LOS did not significantly differ between groups (p =.254).

Implementation of a standardized dexmedetomidine infusion protocol in the pediatric catheterization laboratory PACU was associated with reduced postoperative agitation and decreased need for rescue medications, without prolonging PACU length of stay. A supplemental review of rebleeding events for the first full year of the protocol use suggested that older patients, often not receiving protocol-directed infusions, may remain at risk for agitation-related rebleeding events. These findings support dexmedetomidine infusions in PACU as an effective adjunct for promoting bedrest compliance and suggest that expanding protocol eligibility beyond children under 5 years of age may enhance its clinical benefit. Further research is warranted to optimize patient selection and confirm these findings in larger, more diverse populations.