Increased utilisation of analgesia and sedation in patients following bidirectional Glenn: evidence for the "Glenn Headache"?

Abstract

Background: Single ventricle patients undergoing bidirectional Glenn palliation subjectively experience increased post-operative agitation and discomfort. This is presumed to be secondary to increased intracranial pressure due to physiologic changes. This state of discomfort has been dubbed the "Glenn headache." The purpose of this study was to determine whether sedation and analgesia requirements were higher in post-operative bidirectional Glenn patients than those of similar age who undergo tetralogy of Fallot or ventricular septal defect repairs.

Methods: Retrospective chart review was performed. Medication use, demographic, and haemodynamic data were collected. Comparisons between all groups were performed using the chi-squared test, Fisher's exact test, Kruskal-Wallis test, and Dunn test.

Results: A total of 96 patients met inclusion criteria. Thirty-nine patients (40.3%) underwent bidirectional Glenn, 36 patients (37.5%) tetralogy of Fallot repair, and 21 patients (21.9%) ventricular septal defect closure. When comparing as needed (PRN) morphine, lorazepam, and oxycodone boluses between the three groups, patients who underwent bidirectional Glenn received significantly more doses in comparison with the other two groups (all p < 0.001). The total dose of morphine (p = 0.001) and dexmedetomidine infusions (p < 0.001) were also higher in the bidirectional Glenn group than in ventricular septal defect patients, but equivalent to tetralogy of Fallot patients. There was no significant difference in post-operative intubation status or total hours of mechanical ventilation when comparing bidirectional Glenn patients to those who underwent both tetralogy of Fallot and ventricular septal defect repairs.

Conclusions: Study demonstrates that patients who undergo bidirectional Glenn have higher analgesic and sedation requirements than similar aged patients who undergo tetralogy of Fallot or ventricular septal defect repairs.