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Journal of Cardiothoracic Surgery

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Open Access 01-12-2021 | Sufentanil | Research article

A comparison of the outcomes of dexmedetomidine and remifentanil with sufentanil-based general anesthesia in pediatric patients for the transthoracic device closure of ventricular septal defects

Authors: Ling-Shan Yu, Wen-Peng Xie, Jian-Feng Liu, Jing Wang, Hua Cao, Zeng-Chun Wang, Qiang Chen

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

Abstract

Objective

To compare the safety and efficacy of dexmedetomidine and remifentanil with sufentanil-based general anesthesia for the transthoracic device closure of ventricular septal defects (VSDs) in pediatric patients.

Methods

A retrospective analysis was performed on 60 children undergoing the transthoracic device closure of VSDs from January 2019 to June 2020. The patients were divided into two groups based on different anesthesia strategies, including 30 cases in group R (dexmedetomidine- and remifentanil-based general anesthesia) and 30 cases in group S (sufentanil-based general anesthesia).

Results

There was no significant difference in preoperative clinical information, hemodynamics before induction and after extubation, postoperative pain scores, or length of hospital stay between the two groups. However, the hemodynamic data of group R were significantly lower than those of group S at the time points of anesthesia induction, skin incision, thoracotomy, incision closure, and extubation. The amount of intravenous patient-controlled analgesia (PCA), the duration of mechanical ventilation, and the length of the intensive care unit (ICU) stay in group R were significantly less than those in group S.

Conclusion

Dexmedetomidine combined with remifentanil-based general anesthesia for the transthoracic device closure of VSDs in pediatric patients is safe and effective.

Minette MS, Sahn DJ. Ventricular septal defects. Circulation. 2006;114(20):2190–7. https://doi.org/10.1161/CIRCULATIONAHA.106.618124.CrossRefPubMed

Chen Q, Cao H, Zhang GC, Chen LW, Li QZ, Qiu ZH. Closure of perimembranous ventricular septal defects with intraoperative device technique: another safe alternative to surgical repair. Thorac Cardiovasc Surg. 2013;61(4):293–9. https://doi.org/10.1055/s-0032-1311532.CrossRefPubMed

Mittnacht AJ, Hollinger I. Fast-tracking in pediatric cardiac surgery--the current standing. Ann Card Anaesth. 2010;13(2):92–101. https://doi.org/10.4103/0971-9784.62930.CrossRefPubMed

Kloth RL, Baum VC. Very early extubation in children after cardiac surgery. Crit Care Med. 2002;30(4):787–91. https://doi.org/10.1097/00003246-200204000-00011.CrossRefPubMed

Vricella LA, Dearani JA, Gundry SR, Razzouk AJ, Brauer SD, Bailey LL. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg. 2000;69(3):865–71. https://doi.org/10.1016/S0003-4975(99)01306-5.CrossRefPubMed

Alghamdi AA, Singh SK, Hamilton BC, Yadava M, Holtby H, Van Arsdell GS, et al. Early extubation after pediatric cardiac surgery: systematic review, meta-analysis, and evidence-based recommendations. J Card Surg. 2010;25(5):586–95. https://doi.org/10.1111/j.1540-8191.2010.01088.x.CrossRefPubMed

Wang ZC, Chen Q, Cao H, Zhang GC, Chen LW, Yu LL, et al. Fast-Track Cardiac Anesthesia for Transthoracic Device Closure of Perimembranous Ventricular Septal Defects in Children: A Single Chinese Cardiac Center Experience. J Cardiothorac Vasc Anesth. 2019;33(5):1262–6. https://doi.org/10.1053/j.jvca.2018.07.008.CrossRefPubMed

Voepel-Lewis T, Merkel S, Tait AR, Trzcinka A, Malviya S. The reliability and validity of the face, legs, activity, cry, Consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg. 2002;95(5):1224–9. https://doi.org/10.1097/00000539-200211000-00020.CrossRefPubMed

Predescu D, Chaturvedi RR, Friedberg MK, Benson LN, Ozawa A, Lee KJ. Complete heart block associated with device closure of perimembranous ventricular septal defects. J Thorac Cardiovasc Surg. 2008;136(5):1223–8. https://doi.org/10.1016/j.jtcvs.2008.02.037.CrossRefPubMed

10.

Deshpande CM, Mohite SN, Kamdi P. Sufentanil vs fentanyl for fast-track cardiac anaesthesia. Indian J Anaesth. 2009;53(4):455–62.PubMedPubMedCentral

11.

Groesdonk HV, Pietzner J, Borger MA, Fassl J, Haentschel D, Paarmann H, et al. The incidence of intraoperative awareness in cardiac surgery fast-track treatment. J Cardiothorac Vasc Anesth. 2010;24(5):785–9. https://doi.org/10.1053/j.jvca.2010.03.018.CrossRefPubMed

12.

Engoren M, Luther G, Fenn-Buderer N. A comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia. Anesth Analg. 2001;93(4):859–64. https://doi.org/10.1097/00000539-200110000-00011.CrossRefPubMed

13.

Weale NK, Rogers CA, Cooper R, Nolan J, Wolf AR. Effect of remifentanil infusion rate on stress response to the pre-bypas phase of paediatric cardiac surgery. Br J Anaesth. 2004;92(2):187–94. https://doi.org/10.1093/bja/aeh038.CrossRefPubMed

14.

Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215–25. https://doi.org/10.1016/S0140-6736(11)60245-6.CrossRefPubMed

15.

Lison S, Schill M, Conzen P. Fast-track cardiac anesthesia: efficacy and safety of remifentanil versus sufentanil. J Cardiothorac Vasc Anesth. 2007;21(1):35–40. https://doi.org/10.1053/j.jvca.2006.03.011.CrossRefPubMed

16.

Howard RF. Current status of pain management in children. JAMA. 2003;290(18):2464–9. https://doi.org/10.1001/jama.290.18.2464.CrossRefPubMed

17.

Zhang X, Zhao X, Wang Y. Dexmedetomidine: a review of applications for cardiac surgery during perioperative period. J Anesth. 2015;29(1):102–11. https://doi.org/10.1007/s00540-014-1857-z.CrossRefPubMed

18.

Soliman R, Zohry G. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Ann Card Anaesth. 2016;19(4):606–13. https://doi.org/10.4103/0971-9784.191570.CrossRefPubMedPubMedCentral

19.

Ren J, Zhang H, Huang L, Liu Y, Liu F, Dong Z. Protective effect of dexmedetomidine in coronary artery bypass grafting surgery. Exp Ther Med. 2013;6(2):497–502. https://doi.org/10.3892/etm.2013.1183.CrossRefPubMedPubMedCentral

20.

Ghai B, Jain K, Saxena AK, Bhatia N, Sodhi KS. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double-blind, and controlled study. Paediatr Anaesth. 2017;27(1):37–44. https://doi.org/10.1111/pan.13010.CrossRefPubMed

21.

Carney L, Kendrick J, Carr R. Safety and effectiveness of Dexmedetomidine in the pediatric intensive care unit (SAD-PICU). Can J Hosp Pharm. 2013;66(1):21–7. https://doi.org/10.4212/cjhp.v66i1.1208.CrossRefPubMedPubMedCentral

22.

Wei L, Deng X, Sui J, Wang L, Liu J. Dexmedetomidine improves intubating conditions without muscle relaxants in children after induction with Propofol and Remifentanil. Anesth Analg. 2015;121(3):785–90. https://doi.org/10.1213/ANE.0000000000000812.CrossRefPubMed

23.

Potts AL, Anderson BJ, Warman GR, Lerman J, Diaz SM, Vilo S. Dexmedetomidine pharmacokinetics in pediatric intensive care--a pooled analysis. Paediatr Anaesth. 2009;19(11):1119–29. https://doi.org/10.1111/j.1460-9592.2009.03133.x.CrossRefPubMed

24.

Cheng X, Zuo Y, Zhao Q, Gu E, Huang Y. Comparison of the effects of Dexmedetomidine and Propofol on hemodynamics and oxygen balance in children with complex congenital heart disease undergoing cardiac surgery. Congenit Heart Dis. 2015;10(3):E123–30. https://doi.org/10.1111/chd.12228.CrossRefPubMed

25.

Hamre MC, Ekbom DC, Handlogten KS, Weingarten TN, Seelhammer TG. Anesthetic management for medialization laryngoplasty performed under concurrent dexmedetomidine, remifentanil, and propofol infusions. J Voic. 2020;34(1):134–9.CrossRef

26.

Regueiro-Purriños M, Fernández-Vázquez F, de Prado AP, Altónaga JR, Cuellas-Ramón C, Ajenjo-Silverio JM, et al. Ventricular arrhythmias and mortality associated with isoflurane and sevoflurane in a porcine model of myocardial infarction. J Am Assoc Lab Anim Sci. 2011;50(1):73–8.PubMedPubMedCentral

27.

Ouattara A, Richard L, Charrière JM, Lanquetot H, Corbi P, Debaene B. Use of cisatracurium during fast-track cardiac surgery. Br J Anaesth. 2001;86(1):130–2. https://doi.org/10.1093/bja/86.1.130.CrossRefPubMed

28.

Czaja AS, Zimmerman JJ. The use of dexmedetomidine in critically ill children. Pediatr Crit Care Med. 2009;10(3):381–6. https://doi.org/10.1097/PCC.0b013e3181a3191f.CrossRefPubMed

29.

Nguyen J, Nacpil N. A comparison between dexmedetomidine and propofol on extubation times in postoperative adult cardiac surgery patients: a systematic review protocol. JBI Database System Rev Implement Rep. 2016;14(11):63–71. https://doi.org/10.11124/JBISRIR-2016-003195.CrossRefPubMed

30.

Hashemian M, Ahmadinejad M, Mohajerani SA, Mirkheshti A. Impact of dexmedetomidine on hemodynamic changes during and after coronary artery bypass grafting. Ann Card Anaesth. 2017;20(2):152–7. https://doi.org/10.4103/aca.ACA_76_16.CrossRefPubMedPubMedCentral

Title: A comparison of the outcomes of dexmedetomidine and remifentanil with sufentanil-based general anesthesia in pediatric patients for the transthoracic device closure of ventricular septal defects
Authors: Ling-Shan Yu
Wen-Peng Xie
Jian-Feng Liu
Jing Wang
Hua Cao
Zeng-Chun Wang
Qiang Chen
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Sufentanil
Ventricular Septal Defect
Incision
Remifentanil
Septal Defect
Thoracotomy
Ventricular Septal Defect
General Anesthesia
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01498-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparison of the outcomes of dexmedetomidine and remifentanil with sufentanil-based general anesthesia in pediatric patients for the transthoracic device closure of ventricular septal defects

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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