Long term use of Dexmedetomidine in Postoperative Pediatric Patients with Congenital Heart Defects

Abstract

Specific Aims: To investigate the safety and efficacy of long-term dexmedetomidine (beyond 7-day use) in pediatric patients with congenital heart defects after undergoing major cardiothoracic surgery. Methods: This study was designed as a retrospective case series between January 2019 and December 2021. Clinical data were extracted from the electronic medical record for five pediatric patients receiving dexmedetomidine for longer than 10 postoperative days (POD). Primary endpoints assessing the hemodynamic safety of dexmedetomidine include the following parameters at POD 0, 7 (average of POD 6-8), POD 14 (average of POD 13-15), and POD 28 (average of POD 27-29): heart rate and mean arterial pressure. To investigate the efficacy of dexmedetomidine, the averages of the following parameters at POD 7, 14, and 28 were collected: total daily dose of milligram morphine equivalent (mg/kg/day) and total daily dose of midazolam equivalents (mg/kg/day). Results: Stable heart rate and mean arterial pressures were observed throughout the length of dexmedetomidine therapy. No episodes of bradycardia or hypotension were seen within the post-operative days studied. The relationship between long-term use of dexmedetomidine and its effect on concurrent opioid and benzodiazepine dosing requirements is inconclusive. Conclusion: Our case series results suggest that long-term dexmedetomidine use may be safe and efficacious in post operative pediatric patients with congenital heart defects. Larger studies are warranted to further confirm its use and clinical significance in this patient population.