The effect of perioperative dexmedetomidine on early extubation time in patients undergoing pediatric cardiac surgical patients: A retrospective cohort study.

Abstract

Background: This study aimed to evaluate the effects of perioperative dexmedetomidine administration on opioid consumption and extubation timing in pediatric patients undergoing congenital heart surgery.

Methods: In this single-center, retrospective cohort study, 112 pediatric patients (aged >1 month to <14 years) undergoing congenital cardiac surgery between January 2021-January 2022 were reviewed. Patients were divided into two groups; dexmedetomidine group (n=55) and a control group (n=57). Primary outcome measures included postoperative opioid consumption and mechanical ventilation duration. Secondary outcomes included high-flow oxygen therapy requirement, non-invasive ventilation, intensive care unit stay length, and reintubation rates.

Results: Demographic characteristics were comparable between groups, although the Dex group had a higher proportion of complex surgical cases (risk adjustment for congenital heart surgery-1 category III: 34.5% vs. 25.9%, p=0.034). Mechanical ventilation duration was significantly longer in the Dex group (1.9±3.4 vs. 0.9±0.8 days, p=0.024), as was the requirement for high-flow oxygen therapy (56.4% vs. 31.0%, p=0.007). No significant differences were observed in non-invasive ventilation use, reintubation rates, or mortality.

Conclusion: Perioperative dexmedetomidine was paradoxically associated with prolonged mechanical ventilation and increased postoperative respiratory support requirements. These findings suggest that dexmedetomidine should be employed as an adjunct rather than a substitute for opioids, particularly in patients undergoing complex procedures. Prospective randomized trials are warranted to refine dexmedetomidine's role in fast-track extubation protocols in this high-risk population.