Oral dexmedetomidine versus midazolam as anesthetic premedication in children undergoing congenital heart surgery

Background: Premedication is required for reducing anxiety and child�s struggling against mask acceptance on anesthesia in pediatric surgery for congenital heart disease. Midazolam has been widely used for this purpose, but because of its side effects, finding an effective replacement with less complication is necessary. Objectives: In the present study, we compared the efficacy of oral midazolam versus dexmedetomidine in terms of anxiolysis and mask acceptance behavior. Patients and Methods: Sixty children aged between 2 and 12 years, and scheduled for on-pump surgery due to a congenital heart disease were randomly assigned into two groups. Oral midazolam (0.5 mg/kg up to 15 mg per patient) and dexmedetomidine (2 μg/kg) were administered 45 minutes pre-anesthesia. Children�s anxiety, mask acceptance behavior, hemodynamic measures, and cardiopulmonary outcomes were recorded and compared. Results: The mean age of patients was 3.96 ± 2.04 years. Twenty-eight (46.7) patients were females. Two drugs have similar effects on cardiopulmonary outcomes and hemodynamic measures (P > 0.05). They equally relieved the children�s anxiety (mean sedation score 1.93 ± 0.63 and 2.0 ± 0.63 for midazolam and dexmedetomidine groups, respectively; P > 0.05), while dexmedetomidine showed a better effect on improving the mask acceptance behavior (mean mask acceptance score 2.58 ± 0.6 and 1.6 ± 0.67 for midazolam and dexmedetomidine, respectively; P < 0.05). Conclusions: It appears reasonable to apply oral premedication with dexmedetomidine 45 minutes before transferring the patient to the operating room when he or she is more prone to resist inhalation anesthesia induction. © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)

Clinical outcomes and electrolyte balance factors in complex cardiac operations in adults; del nido versus custodiol cardioplegia solutions: A randomized controlled clinical trial

Background: Cardioplegia is used for protection of myocardium during cardiac operations. Del Nido (DN) and Custodiol cardioplegia solutions are used for prolonged protection of the myocardium during cardiopulmonary bypass (CPB). Custodiol cardioplegia (CC) solution is gaining popularity for myocardial protection during cardiopulmonary bypass. Objectives: This study aimed to compare the effects of Custodiol with another cardioplegia solution, Del Nido, on myocardial protection during cardiopulmonary bypass. Methods: In a randomized controlled clinical trial, forty patients were randomly allocated to DN and Custodiol (CC) groups. Patients in both groups received a normal anesthesia protocol. For cardioplegia, in the DN group, the DN solution was administered every 90 minutes by the antegrade route. In the Custodiol group, the Custodiol solution was administered in the same way at the beginning of the cardioplegia. Demographic information, blood chemistry parameters and other related perioperative and postoperative clinical indices were recorded. Results: Frequency of female patients was 14/21 (66.66) in the DN and 12/19 (63.15) in the CC group (P = 0.816), age was 57.14 ± 12.48 years in the DN and 59.47 ± 11.96 years in the CC group (P = 0.551), weight was 70.95 ± 9.56 kilograms in the DN and 69.63 ± 7.64 kilograms in the CC group (P = 0.635), CPB time was103.19 ± 23.43 minutes in the DN versus 97.36 ± 16.7 minutes in the CC group (P = 0.376), and cross-clamp time was 73.76 ± 19.66 minutes in the DN and 83.95 ± 16.14 minutes in the CC group (P = 0.083). Blood chemistry and blood gas analysis revealed a similar trend between the two groups in these parameters (P > 0.05) except for higher sodium levels after cardioplegia (P = 0.016) and end of CPB (P = 0.002), potassium levels after cardioplegia (P = 0.029), and bicarbonate anions at the end of bypass (P = 0.03) in the custodiol group. Conclusions: In conclusion, CC and DN offer effective myocardial protection during cardiopulmonary bypass. It is recommended to restrict the use of CC in patients susceptible to electrolyte disturbances. © 2018, Author(s)

Effects of dexmedetomidine on clinical outcomes and renal function after CABG

Background: This study was carried out to determine the effects of dexmedetomidine on clinical outcomes and renal function after coronary artery bypass grafting (CABG) to address the increased rate of CABG? and the importance of modification in stress responses and control of adverse effects on renal function and with the aim of cost reduction. Materials and Methods: This double-blind randomized clinical trial was carried out with the participation of 129 subjects under elective CABG in Rajaei Heart Center, Tehran, Iran in 2017. Patients were randomly assigned to four groups with simple randomization including one placebo (normal saline infusion) group and three dexmedetomidine groups; 0.5 µg/kg/h on CPB, 0.5 µg/kg/h in 24 hours, and 0.75 µg/kg/h in 24 hours. The blood pressure, blood urea nitrogen (BUN), serum creatinine, transfused blood volume, urine volume, and hemofiltration on pump and lactate were assessed at different time intervals. Results: Results showed more stability especially in central venous pressure (CVP) (p=0.001) and systolic blood pressure (p=0.006) in the groups receiving dexmedetomidine 0.75 µg/kg/h per 24 hours. But diastolic blood pressure and heart rate were the same across the groups (p>0.05). All other variables including hepatic and renal function tests were the same across the groups (P>0.05). Conclusion: Overall, according to the obtained results in the current study, it may be concluded that dexmedetomidine would have some promising effects on hemodynamic stability but there are no obvious renoprotective effects for this medication. © 2021 Journal of Cellular and Molecular Anesthesia. All rights reserved