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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 Mar 07

DOI: 10.23736/S0375-9393.18.12213-9


language: English

Use of low dose dexmedetomidine in combination with opioids and midazolam in paediatric cardiac surgical patients: randomized controlled trial

Cristiana GARISTO 1 , Zaccaria RICCI 1, Lorenzo TOFANI 2, Simona BENEGNI 1, Chiara PEZZELLA 3, Paola COGO 4

1 Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy; 2 Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy; 3 ASL TO 3, Susa-Rivoli Hospital, Rivoli, Turin, Italy; 4 University of Udine, Department of Medicine, Udine, Italy


BACKGROUND: Dexmedetomidine is a selective agonist of α2 receptors that induces hypnotic, sedative and mild analgesic effect. The aim of our study was to test the effects of dexmedetomidine in combination with opioids and benzodiazepines compared to benzodiazepine-opioids alone.
METHODS: A randomized controlled trial was conducted. Patients (children >30 days and <24 months undergoing correction of complex congenital heart diseases -CHD-) were randomized to receive 0.5 mcg/kg/h dexmedetomidine in addition to half dose of opioids and benzodiazepines (D- CASES) or standard dose opioids and benzodiazepines (CONTROLs). Primary outcome: to compare the duration of mechanical ventilation (MV) in D-CASEs and CONTROLs. Secondary outcomes: 1) the degree of sedation, 2) the onset of withdrawal symptoms, 3) the occurrence bradycardia and hypotension.
RESULTS: Overall, 48 patients, 26 in CONTROLs group and 22 in D-CASEs group were ultimately included in the analysis after enrollment. The median duration of MV was 33.5 (16.7-75) hours in CONTROLs and 41.5 (23.7-71.2) hours in D-CASEs (p=0.51). Dexmedetomidine did not affect COMFORT and FLACC scales but it reduced the SOS scale in 15 D-CASEs vs 11 CONTROLs (p=0.001). The incidence of bradycardia and hypotension and vasoactive support did not show significant differences in the two groups.
CONCLUSIONS: Low dose of dexmedetomidine in combination with morphine and midazolam was safe in a high-risk cohort of CHD children after cardiac surgery and reduced the onset of withdrawal symptoms. However, it did not decrease MV time and the total amount of other sedative and analgesic drugs required in the post-operative period.

KEY WORDS: Dexmedetomidine - Congenital heart disease - Sedation - Mechanical ventilation - Cardiopulmonary bypass - Withdrawal syndrome

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Publication History

Article first published online: March 7, 2018
Manuscript accepted: March 6, 2018
Manuscript revised: January 22, 2018
Manuscript received: June 1, 2017

Cite this article as

Garisto C, Ricci Z, Tofani L, Benegni S, Pezzella C, Cogo P. Use of low dose dexmedetomidine in combination with opioids and midazolam in paediatric cardiac surgical patients: randomized controlled trial. Minerva Anestesiol 2018 Mar 07. DOI: 10.23736/S0375-9393.18.12213-9

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