Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery

Background Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia af...

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Main Authors: Doaa Mohamed El Amrousy, Nagat S. Elshmaa, Mohamed El‐Kashlan, Samir Hassan, Mohamed Elsanosy, Nahed Hablas, Shimaa Elrifaey, Wael El‐Feky
Format: Article
Language:English
Published: Wiley 2017-03-01
Series:Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
Subjects:
Online Access:https://www.ahajournals.org/doi/10.1161/JAHA.116.004780
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author Doaa Mohamed El Amrousy
Nagat S. Elshmaa
Mohamed El‐Kashlan
Samir Hassan
Mohamed Elsanosy
Nahed Hablas
Shimaa Elrifaey
Wael El‐Feky
author_facet Doaa Mohamed El Amrousy
Nagat S. Elshmaa
Mohamed El‐Kashlan
Samir Hassan
Mohamed Elsanosy
Nahed Hablas
Shimaa Elrifaey
Wael El‐Feky
author_sort Doaa Mohamed El Amrousy
collection DOAJ
description Background Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. Methods and Results A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005). Conclusion Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.
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spelling doaj.art-6930a24a6d2647299f9b0fc1672bae3d2022-12-22T01:51:52ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-03-016310.1161/JAHA.116.004780Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac SurgeryDoaa Mohamed El Amrousy0Nagat S. Elshmaa1Mohamed El‐Kashlan2Samir Hassan3Mohamed Elsanosy4Nahed Hablas5Shimaa Elrifaey6Wael El‐Feky7Pediatric Department Tanta University Hospital Tanta EgyptDepartment of Anesthesia &amp; Surgical ICU Faculty of Medicine Tanta University Tanta EgyptDepartment of Anesthesia &amp; Surgical ICU Faculty of Medicine Tanta University Tanta EgyptPediatric Department Tanta University Hospital Tanta EgyptPediatric Department Tanta University Hospital Tanta EgyptPediatric Department Tanta University Hospital Tanta EgyptPediatric Department Tanta University Hospital Tanta EgyptCardiothoracic Surgery Department Tanta University Hospital Tanta EgyptBackground Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. Methods and Results A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005). Conclusion Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.https://www.ahajournals.org/doi/10.1161/JAHA.116.004780childrendexmedetomidinepostoperative junctional ectopic tachycardia
spellingShingle Doaa Mohamed El Amrousy
Nagat S. Elshmaa
Mohamed El‐Kashlan
Samir Hassan
Mohamed Elsanosy
Nahed Hablas
Shimaa Elrifaey
Wael El‐Feky
Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
children
dexmedetomidine
postoperative junctional ectopic tachycardia
title Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
title_full Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
title_fullStr Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
title_full_unstemmed Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
title_short Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery
title_sort efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia after pediatric cardiac surgery
topic children
dexmedetomidine
postoperative junctional ectopic tachycardia
url https://www.ahajournals.org/doi/10.1161/JAHA.116.004780
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