Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta‐analysis
| Autor: | Wanying Pan, Liqiu Mo, Xiaoxiao Hua, Yueting Wang, Ge Zhou, Lin Lin |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Blood Glucose Heart Defects Congenital medicine.medical_specialty Adolescent Hydrocortisone medicine.medical_treatment 030204 cardiovascular system & hematology Cochrane Library Lower risk Placebo law.invention Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law medicine Humans Hypnotics and Sedatives Dexmedetomidine Child Randomized Controlled Trials as Topic Mechanical ventilation business.industry Hemodynamics Delirium Infant Perioperative Length of Stay Respiration Artificial Intensive care unit Surgery Treatment Outcome Anesthesiology and Pain Medicine Child Preschool Anesthesia Pediatrics Perinatology and Child Health business medicine.drug |
| Zdroj: | Pediatric Anesthesia. 26:239-248 |
| ISSN: | 1460-9592 1155-5645 |
| Popis: | SummaryBackground Dexmedetomidine decreases cardiac complications in adults undergoing cardiovascular surgery. This systematic review assessed whether perioperative dexmedetomidine improves congenital heart disease (CHD) surgery outcomes in children. Methods The PubMed, Embase, and Cochrane Library databases were searched for randomized controlled trials (RCTs) or observational studies that were published until 16 April 2015 and compared dexmedetomidine with placebo or an alternative anesthetic agent during pediatric CHD surgery. The assessed outcomes included hemodynamics, ventilation length, intensive care unit (ICU) and hospital stays, blood glucose and serum cortisol levels, postoperative analgesia requirements, and postoperative delirium. Results Five RCTs and nine observational studies involving 2229 patients were included. In pooled analyses, dexmedetomidine was associated with shorter length of mechanical ventilation (mean difference: −93.36, 95% CI: −137.45, −49.27), lower postoperative fentanyl (mean difference: −24.11, 95% CI: −36.98, −11.24) and morphine (mean difference: −0.07, 95% CI: −0.14, 0.00) requirements, reduced stress response (i.e., lower blood glucose and serum cortisol levels), and lower risk of delirium (OR: 0.39, 95% CI: 0.21, 0.74). The hemodynamics of dexmedetomidine-treated patients appeared more stable, but there were no significant differences in the ICU or hospital stay durations. Dexmedetomidine may increase the bradycardia and hypotension risk (OR: 3.14, 95% CI: 1.47, 6.69). Conclusions Current evidence indicates that dexmedetomidine improves outcomes in children undergoing CHD surgery. However, this finding largely relies on data from observational studies; high-quality RCTs are warranted because of the potential for subject selection bias. |
| Databáze: | OpenAIRE |
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