The efficacy of pre‑emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery.
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Date
2016-10
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Abstract
Objective: The objective of this study was to assess the effectiveness of pre‑emptive dexmedetomidine versus
amiodarone in preventing junctional ectopic tachycardia (JET) in pediatric cardiac surgery. Design: This is
a prospective, controlled study. Setting: This study was carried out at a single university hospital. Subjects
and Methods: Ninety patients of both sexes, American Society of Anesthesiologists Physical Status II and
III, age range from 2 to 18 years, and scheduled for elective cardiac surgery for congenital and acquired
heart diseases were selected as the study participants. Interventions: Patients were randomized into
three groups (30 each). Group I received dexmedetomidine 1 mcg/kg diluted in 100 ml of normal saline
intravenously (IV) over a period of 20 min, and the infusion was completed 10 min before the induction
followed by a 0.5 mcg/kg/h infusion for 72 h postoperative, Group II received amiodarone 5 mg/kg diluted
in 100 ml of normal saline IV over a period of 20 min, and the infusion was completed 10 min before the
induction followed by a 10–15 mcg/kg/h infusion for 72 h postoperative, and Group III received 100 ml of
normal saline IV. Primary outcome was the incidence of postoperative JET. Secondary outcomes included
vasoactive‑inotropic score, ventilation time (VT), pediatric cardiac care unit stay, hospital length of stay, and
perioperative mortality. Measurements and Main Results: The incidence of JET was significantly reduced
in Group I and Group II (P = 0.004) compared to Group III. Heart rate while coming off from cardiopulmonary
bypass (CPB) was significantly low in Group I compared to Group II and Group III (P = 0.000). Mean VT, mean
duration of Intensive Care Unit stay, and length of hospital stay (day) were significantly short (P = 0.000) in
Group I and Group II compared to Group III (P = 0.000). Conclusion: Perioperative use of dexmedetomidine
and amiodarone is associated with significantly decreased incidence of JET as compared to placebo without
significant side effects.
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Keywords
Amiodarone, Children, Junctional ectopic tachycardia, Dexmedetomidine, Postoperative arrhythmia
Citation
El-Shmaa Nagat S, Amrousy Doaa El, Feky Wael El. The efficacy of pre‑emptive dexmedetomidine versus amiodarone in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery. Annals of Cardiac Anaesthesia. 2016 Oct; 19(4): 614-620.