Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis

Qing Wang, Chuikai Chen, Li Wang, Qing Wang, Chuikai Chen, Li Wang

Abstract

Objectives: Dexmedetomidine (DEX) is a highly selective alpha-2 adrenergic receptor agonist, which is the main sedative in the intensive care unit. This study aims to investigate the effectiveness and adverse events of DEX in maintaining hemodynamic stability in pediatric cardiac surgery.

Sources: Databases such as PubMed, Cochrane, Web of Science, WANFANG STATA and China National Knowledge Infrastructure were searched for articles about the application of DEX in maintaining hemodynamic stability during and after pediatric cardiac surgery up to 18th Feb. 2021. Only randomized controlled trials were included and random-effects model meta-analysis was applied to calculate the standardized mean deviation (SMD), odds ratio (OR) and 95% confidence interval (CI).

Summary of the findings: Fifteen articles were included for this meta-analysis, and 9 articles for qualitative analysis. The results showed that preoperative prophylaxis and postoperative recovery of DEX in pediatric patients undergoing cardiac surgery were effective in maintaining systolic blood pressure (SBP), mean arterial pressure (MAP), diastolic blood pressure (DBP) and reducing heart rate (HR) (SBP: SMD = -0.35,95% CI: -0.72, 0.01; MAP: SMD = -0.83, 95% CI: -1.87,0.21; DBP: SMD = -0.79,95% CI: -1.66,0.08; HR: SMD = -1.71,95% CI: -2.29, -1.13). In addition, the frequency of Junctional Ectopic Tachycardia in the DEX treatment group was lower than that in the placebo group.

Conclusions: The application of DEX for preoperative prophylaxis and postoperative recovery in pediatric cardiac surgery patients are effective in maintaining hemodynamic stability, and the clinical dose of DEX is not significantly related to the occurrence of pediatric adverse events which may be related to individual differences.

Keywords: Cardiac surgery; Dexmedetomidine; Hemodynamics; Infant patients.

Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Copyright © 2021 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1
Figure 1
Study selection flowchart, systematic review and meta-analysis of the role of dexmedetomidine in efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery.
Figure 2
Figure 2
Risk of bias graph: Review authors' judgments about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary: Review authors' judgments about each risk of bias item for each included study.
Figure 4
Figure 4
Forest plot of comparison between before and after infusion of DEX: A, systolic blood pressure; B, mean arterial blood pressure.
Figure 5
Figure 5
Forest plot of comparison between before and after infusion of DEX: A, diastolic blood pressure; B, central venous pressure.
Figure 6
Figure 6
Forest plot of comparison between before and after infusion of DEX and Comparison between Dexmedetomidine and Control (Placebo): A, heart rate; B, junctional ectopic tachycardia.

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Source: PubMed

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