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Dexmedetomidine utilisation and outcomes of children with trisomy 21 undergoing congenital heart disease surgery

Published online by Cambridge University Press:  27 August 2014

Brady S. Moffett ,
Emad B. Mossad ,
Joseph D. Tobias  and
Antonio G. Cabrera
Brady S. Moffett*
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas, United States of America
Emad B. Mossad
Affiliation:
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas, United States of America
Joseph D. Tobias
Affiliation:
Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
Antonio G. Cabrera
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas, United States of America
*
Correspondence to: B. S. Moffett, PharmD, MPH, Department of Pharmacy, Texas Children’s Hospital, 6621 Fannin Street, Suite WB 1120, Houston, TX 77030, United States of America. Tel: +832 824 6087; Fax: 832 825 5261; E-mail: bsmoffet@texaschildrens.org
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Abstract

Introduction: The diagnosis of trisomy 21 in children has been associated with failed extubation after CHD surgery. Dexmedetomidine may be a useful agent to improve postoperative outcomes in these patients, such as ventilator time, ICU length of stay, or hospital length of stay. Materials and methods: The Pediatric Health Information System database was queried from January, 2008 to December, 2010 for patients with trisomy 21 who underwent CHD surgery. Patients who received dexmedetomidine were matched to patients who did not by propensity score. The primary outcome was ventilator days charged, and secondary outcomes included ICU and hospital length of stay. Results: A total of 1088 patients (544 matched pairs) met inclusion criteria. Patient characteristics were similar, with the exception of more patients in the dexmedetomidine group undergoing repair of complete atrioventricular canal and fewer undergoing mechanical valve replacement (p<0.01). More patients in the dexmedetomidine group were administered milrinone, epinephrine, vasopressin, benzodiazepines, opiates, and adjunct pain and sedative medications (p<0.01). The dexmedetomidine group had greater time on the ventilator [7 (4.5–11) versus 6 (4–10) days (median, interquartile range) p<0.01] and similar ICU length of stay, hospital length of stay, and mortality compared with controls. Mixed-effects modelling clustered on institution did not show beneficial effect of dexmedetomidine on ventilator time, ICU stay, or hospital length of stay. Conclusions: The use of dexmedetomidine was not associated with the decreased ventilatory time. Routine use of dexmedetomidine is not warranted in this patient population.

Keywords

Dexmedetomidinetrisomy 21ventilatorcardiac surgerypaediatric
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 5 , June 2015 , pp. 958 - 962
Copyright
© Cambridge University Press 2014 

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