Pediatric Cardiology and Congenital Cardiovascular Disease

Biography

Biography: Christopher F Tirotta

Abstract

Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist with sedative, analgesic and anxiolytic properties. DEX has not been approved for use in pediatrics. DEX has been reported to depress sinus node and atrioventricular (AV) nodal function in pediatric patients; it was even suggested that the use of DEX may not be desirable during electrophysiological studies (EPS). Other studies have reported no association between DEX use and any significant EKG interval abnormalities in patients with congenital heart disease, other than a decrease in HR. We reviewed all cases presented to the CCL for diagnosis or treatment of atrial tachyarrhythmias since 2007. The patients were stratified into three different groups. Group 1 patients did not receive any DEX. Group 2 patients received a DEX infusion of 0.5-1 mcg/kg/hr. Group 3 patients received a DEX infusion of 0.5-1 mcg/kg/hr and a DEX bolus prior to the infusion of 0.5-1 mcg/kg. We then compared those patients for the following variables: Demographic data and anesthetic data like age, sex, height, weight; mask vs. IV induction, identity of induction agent, amount of sevoflurane and propofol used; amount of DEX used; presence of congenital heart disease and other co-morbidities; the need for isoproterenol (ISO) and dose, the need for adenosine and dose and the need for any other medications to effect rhythm both before and after RFA; the ability to induce the arrhythmia, the type of arrhythmia, the presence of Wolf-Parkinson-White (WPW) syndrome, the presence of an accessory pathway, the ablation rate and the recurrence rate. There were no differences in any of the demographic data between groups. There was no difference in the anesthetic data, except there was a lesser amount of propofol and sevoflurane used in the DEX groups. There was no difference in the electrophysiologic parameters between groups, except the Group 1 patients did require the use of ISO in the pre-ablation period less often compared to the DEX groups. However, there was no difference in the ability to induce the arrhythmia, the percentage of patients ablated, and the recurrence rate between groups.