Department of Pediatric Intensive Care Unit, Children's Hospital, Nantes University Hospital, 44000, Hôpital Femme-Enfant-Adolescent - CHU de Nantes, 38 Bd Jean Monnet, 44093, Nantes, France.
Department of Pediatric Nephrology, Children's Hospital, Nantes University Hospital, 44000, Nantes, France.
Pediatr Nephrol. 2025 Jan;40(1):213-221. doi: 10.1007/s00467-024-06483-6. Epub 2024 Sep 4.
Dexmedetomidine is increasingly used for its ability to stabilise haemodynamic status during general anaesthesia. However, there is currently no data on paediatric kidney transplant recipients (pKTR). This study investigates the haemodynamic impact of dexmedetomidine administered perioperatively in pKTR.
From 2019 to 2023, a retrospective study was conducted at Nantes University Hospital involving all pKTR under 18 years of age. The study compared intraoperative haemodynamic parameters between patients administered dexmedetomidine during kidney transplantation (DEX group) and those who did not receive it (no-DEX group). Mean arterial pressure (MAP) and heart rate (HR) were monitored throughout the duration of anaesthesia and compared. Graft function was assessed based on creatinine levels and glomerular filtration rate (GFR) at specific intervals. The perioperative use of fluids and vasoactive drugs, as well as their administration within 24 h post-surgery, were analysed.
Thirty-eight patients were enrolled, 10 in the DEX group and 28 in the no-DEX group. Intraoperative HR was similar between the groups; however, MAP was higher in the DEX group (mean difference 9, standard deviation (SD, 1-11) mmHg, p = 0.039). No differences were found regarding the use of fluid and vasoactive drug therapy between groups. GFR at 1 month post-transplantation was significantly elevated in the DEX group (p = 0.009).
pKTR receiving intraoperative dexmedetomidine exhibited higher perioperative MAP compared to those not administered dexmedetomidine. Additionally, the DEX group demonstrated superior graft function at 1 month. The direct impact of dexmedetomidine on immediate postoperative graft function in pTKR warrants further investigation in a prospective multicentre randomised study.
右美托咪定因其在全身麻醉期间稳定血液动力学状态的能力而被越来越多地使用。然而，目前尚无儿科肾移植受者（pKTR）的数据。本研究调查了术中给予右美托咪定对 pKTR 的血液动力学影响。
2019 年至 2023 年，在南特大学医院进行了一项回顾性研究，纳入所有 18 岁以下的 pKTR。研究比较了接受肾移植期间给予右美托咪定的患者（DEX 组）和未给予右美托咪定的患者（无 DEX 组）的术中血液动力学参数。在整个麻醉过程中监测平均动脉压（MAP）和心率（HR）并进行比较。根据特定时间间隔的肌酐水平和肾小球滤过率（GFR）评估移植物功能。分析围手术期液体和血管活性药物的使用情况以及术后 24 小时内的给药情况。
共纳入 38 例患者，其中 DEX 组 10 例，无 DEX 组 28 例。两组术中 HR 相似；然而，DEX 组的 MAP 更高（平均差异 9mmHg，标准差（SD，1-11）mmHg，p=0.039）。两组之间液体和血管活性药物治疗的使用无差异。移植后 1 个月时，DEX 组的 GFR 显著升高（p=0.009）。
接受术中右美托咪定的 pKTR 与未接受右美托咪定的患者相比，围手术期 MAP 更高。此外，DEX 组在 1 个月时移植物功能更好。DEX 对 pTKR 术后即刻移植物功能的直接影响需要在一项前瞻性多中心随机研究中进一步研究。
