Schwartz Lawrence I, Twite Mark, Gulack Brian, Hill Kevin, Kim Sunghee, Vener David F
From the *Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado; †Department of Surgery, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina; ‡Department of Pediatrics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina; §Department of Biostatistics, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina; and ‖Department of Anesthesiology, Pediatric Cardiovascular Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Anesth Analg. 2016 Sep;123(3):715-21. doi: 10.1213/ANE.0000000000001314.
Dexmedetomidine is a selective α-2 receptor agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic for pediatric patients with congenital heart disease (CHD). Although several smaller, single-center studies suggest that dexmedetomidine use is gaining traction in the perioperative setting in children with CHD, there are limited multicenter data, with little understanding of the variation in use across age ranges, procedural complexity, and centers. The aim of this study was to use the Congenital Cardiac Anesthesia Society-Society of Thoracic Surgeons (CCAS-STS) registry to describe patient- and center-level variability in the use of dexmedetomidine in the perioperative setting in children with heart disease.
To describe the use of dexmedetomidine in patients for CHD surgery, we analyzed all index cardiopulmonary bypass operations entered in the CCAS-STS database from 2010 to 2013. Patient and operative characteristics were compared between those who received intraoperative dexmedetomidine and those who did not. Selective outcomes associated with dexmedetomidine use were also described.
Of the 12,142 operations studied, 3600 (29.6%) received perioperative dexmedetomidine (DEX) and 8542 did not receive the drug (NoDEX). Patient characteristics were different between the 2 groups with the DEX group generally exhibiting both lower patient and procedural risk factors. Patients who received dexmedetomidine were more likely to have a lower level of Society of Thoracic Surgeons mortality complexity than patient who did not receive it. Consistent with their overall lower risk profile, children in the DEX group also demonstrated improved outcomes compared with patients who did not receive dexmedetomidine.
We described the growing use of dexmedetomidine in children anesthetized for surgical repair of CHD. Dexmedetomidine appears to be preferentially given to older and larger children who are undergoing less complex CHD surgery. We believe that the data provided in this study are the largest investigating the use of an anesthetic drug in CHD patients. It is also the first analysis of the anesthesia data in the CCAS-STS Congenital Heart Disease database.
右美托咪定是一种选择性α-2受体激动剂，具有镇静和心肺方面的特性，使其成为先天性心脏病（CHD）患儿有吸引力的麻醉剂。尽管一些规模较小的单中心研究表明，右美托咪定在CHD患儿围手术期的应用越来越受到关注，但多中心数据有限，对不同年龄范围、手术复杂性和中心之间使用差异的了解甚少。本研究的目的是利用先天性心脏麻醉学会-胸外科医师协会（CCAS-STS）登记处的数据，描述心脏病患儿围手术期右美托咪定使用在患者和中心层面的变异性。
为了描述右美托咪定在CHD手术患者中的使用情况，我们分析了2010年至2013年录入CCAS-STS数据库的所有首次体外循环手术。比较了术中接受右美托咪定和未接受右美托咪定患者的患者和手术特征。还描述了与使用右美托咪定相关的选择性结局。
在研究的12142例手术中，3600例（29.6%）接受了围手术期右美托咪定（DEX），8542例未接受该药物（NoDEX）。两组患者特征不同，DEX组通常显示出较低的患者和手术风险因素。接受右美托咪定的患者比未接受右美托咪定的患者更有可能具有较低的胸外科医师协会死亡率复杂性水平。与总体较低的风险特征一致，DEX组患儿与未接受右美托咪定的患者相比，结局也有所改善。
我们描述了右美托咪定在接受CHD手术修复麻醉的患儿中使用日益增加的情况。右美托咪定似乎优先给予年龄较大、体型较大且接受不太复杂CHD手术的患儿。我们认为，本研究提供的数据是调查麻醉药物在CHD患者中使用情况的最大规模数据。这也是对CCAS-STS先天性心脏病数据库中麻醉数据的首次分析。
