The role of dexmedetomidine in fast-track extubation for closed congenital heart surgery in children: a randomized double-blinded placebo-controlled trial

Background
The definition of early extubation is not well-established; some authors extended its time to 24 h postoperatively. In our study, we tried to extubate the patients by the end of the surgery. We investigated the role of dexmedetomidine use during induction of anesthesia in the improvement of outcomes with fast-track extubation in children undergoing cardiac surgery. We assumed that the use of dexmedetomidine will help in extubating the patients at the end of operation with decreased use of inhalational anesthetic and fentanyl, thus improving oxygenation and decreasing the need for analgesia postoperatively.
Patients and methods
A study was conducted in a population of 84 pediatric patients scheduled for closed congenital heart surgery. Patients were randomly allocated to two groups: group D (42 patients), which received a single dose of dexmedetomidine 0.4 mg/kg over 10 min in the induction of anesthesia, and group C (42 patients), which received normal saline. Both groups were compared in relation to percentage of extubated patients by the end of the surgery as primary outcome. Hemodynamics (mean arterial blood pressure and heart rate), sevoflurane consumption, fentanyl consumption, incidence of postoperative infection, and length of ICU stay were recorded. Arterial blood gases were analyzed before extubation and in the ICU 1 and 3 h after transfer to the ICU.
Results
Compared with the control group, group D showed lower intraoperative sevoflurane and fentanyl consumption (14.2±2.9 vs. 37.8±24.1, <0.01; 48±12.5 vs. 85.2±43.2, <0.01). The blood pressure at T1 and T2 showed a statistically significant decrease compared with baseline (=0.05 and 0.01, respectively) and heart rate showed a significant decrease (=0.05) at T1 and (<0.01) at T2. Group D showed a higher incidence of successful extubation (64 vs. 26.7%, =0.04) and higher pO after extubation (82±28.45 vs. 68±0.23, =0.04). The length of ICU stay was lower in group D (1.8±0.8) compared with 5.5±3.2 in the control group (<0.01), and the incidence of postoperative infections was lower in group D compared with group C (29.4 vs. 65.2%, =0.04).
Conclusion
Adding dexmedetomidine as an adjuvant to induction of anesthesia in children undergoing congenital heart surgery improved the success of extubation, the oxygenation, and decreased the length of hospital stay.