Impact of dexmedetomidine on early extubation in pediatric cardiac surgical patients

Abstract

Purpose: To evaluate the impact of dexmedetomidine on early extubation in post-operative pediatric cardiac patients compared to patients on standard sedation regimens without dexmedetomidine.

Methods: Retrospective study comparing dexmedetomidine infusion (DEX) to our standard sedation regimens (control).

Results: A total of 269 patients were included (control: n = 180; DEX: n = 89). The mean duration of DEX was 34 ± 2 h. Extubation was achieved in the operating room in 42% of the control group and 42% of the DEX group. Extubation within 24 h of surgery was achieved in 75% of the control group and 76% of the DEX group. Ventilator time in the DEX group was 35 ± 29 h compared to 29 ± 35 h in the control group. The mean cardiovascular intensive care unit (CV ICU) and hospital length of stays were 3 ± 2 and 8 ± 4 days in the DEX group and 3 ± 3 and 8 ± 5 days in the control group. Reintubation rates in the CV ICU were not significantly different. DEX patients received significantly less total intraoperative fentanyl and midazolam but significantly more midazolam rescue doses than the control group in the postoperative period. Post-extubation ventilation was clinically similar in the DEX group as measured by 1 h post-extubation PaCO₂ levels.

Conclusions: Dexmedetomidine did not significantly impact the postoperative course of children compared to standard practice as measured by success of early extubation, ventilator time, and length of stay.