Analysis of Remifentanil-Based Fast-Track Anesthesia Combined with Dexmedetomidine for Transthoracic Device Closure of Atrial Septal Defect in Pediatric Patients

Authors

  • Ling-Shan Yu, MM Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • Yu-Qing Lei, MM Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • Jian-Feng Liu, MM Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • Jing Wang, MD Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • Hua Cao, MD Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • Zeng-Chun Wang, MD Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
  • Qiang Chen, MD Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China

DOI:

https://doi.org/10.1532/hsf.3429

Keywords:

fast-track cardiac anesthesia, atrial septal defect, cardiac intervention

Abstract

Background: To investigate the safety and efficacy of remifentanil combined with dexmedetomidine in fast-track cardiac anesthesia (FTCA) for transthoracic device closure of atrial septal defect (ASD) in pediatric patients.

Methods: A retrospective analysis was performed on 61 cases of children undergoing ASD closure through a small thoracic incision from January 2018 to January 2020. According to whether FTCA was administered, they were divided into group F (fast-track anesthesia, n = 31) and group R (routine anesthesia, n = 30).

Results: There was no significant difference in general preoperative data, perioperative hemodynamics, or postoperative pain scores between the 2 groups (P > .05). The postoperative sedation score of group F was higher than that of group R 1 and 4 hours after extubation. Meanwhile, duration of mechanical ventilation and length of postoperative intensive care unit (ICU) stay of group F were significantly shorter than those of group R (P < .05). No serious anesthesia-related complications occurred.

Conclusion: Remifentanil combined with dexmedetomidine in FTCA for transthoracic device closure of ASD in pediatric patients is safe and effective, is worthy of clinical promotion, and can benefit more children.

References

Alghamdi AA, Singh SK, Hamilton BC, Yadava M, Holtby H, Van Arsdell GS, Al-Radi OO. Early extubation after pediatric cardiac surgery: Systematic review, meta-analysis, and evidence-based recommendations. J Card Surg 2010;25:586-595.

Blaine Easley R, Brady KM, Tobias JD. Dexmedetomidine for the treatment of postanesthesia shivering in children. Paediatr Anaesth 2007;17:341-346.

Carney L, Kendrick J, Carr R. Safety and effectiveness of dexmedetomidine in the pediatric intensive care unit (SAD-PICU). Can J Hosp Pharm 2013;66:21-27.

Chen Q, Cao H, Zhang G-C, Chen L-W, Chen D-Z. Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. Eur J Cardiothorac Surg 2012;41:121-125.

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:E123-E130.

Deshpande CM, Mohite SN, Kamdi P. Sufentanil vs fentanyl for fast-track cardiac anaesthesia. Indian J Anaesth 2009;53:455-462.

Dickinson DF, Arnold R, Wilkinson JL. Congenital heart disease among 160,480 live-born children in Liverpool 1960 to 1969. Implications for surgical treatment. Br Heart J 1981;46:55-62.

Engoren M, Luther G, Fenn-Buderer N. A Comparison of fentanyl, sufentanil, and remifentanil for fast-track cardiac anesthesia. Anesth Analg 2001;93:859-864.

Friesen RH, Veit AS, Archibald DJ, Campanini RS. A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia. Paediatr Anaesth 2003;13:122-125.

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;27:37-44.

Groesdonk HV, Pietzner J, Borger MA, Fassl J, Haentschel D, Paarmann H, Ender J. The incidence of intraoperative awareness in cardiac surgery fast-track treatment. J Cardiothorac Vasc Anesth 2010;24:785-789.

Harris KC, Holowachuk S, Pitfield S, Sanatani S, Froese N, Potts JE, Gandhi SK. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg 2014;148:2642-2647.

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;20:152-157.

Huang Q, Lin L-Y, Lin X-Z. Comparison of remifentanil-based fast-track and fentanyl-based routine cardiac anesthesia for intraoperative device closure of atrial septal defect (ASD) in pediatric patients. Med Sci Monit 2019;25:1187-1193.

Lison S, Schill M, Conzen P. Fast-track cardiac anesthesia: Efficacy and safety of remifentanil versus sufentanil. J Cardiothorac Vasc Anesth 2007;21:35-40.

Martinez JL, Sutters KA, Waite S, Davis J, Medina E, Montano N, et al. A comparison of oral diazepam versus midazolam, administered with intravenous meperidine, as premedication to sedation for pediatric endoscopy. J Pediatr Gastroenterol Nutr 2002;35:51-58.

Mittnacht AJ, Hollinger I. Fast-tracking in pediatric cardiac surgery—The current standing. Ann Card Anaesth 2010;13:92-101.

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;14:63-71.

Pastorek J, Allen H, Davis J. Current outcomes of surgical closure of secundum atrial septal defect. Am J Cardiol 1994;74:75-77.

Reismann M, von Kampen M, Laupichler B, Suempelmann R, Schmidt AI, Ure BM. Fast-track surgery in infants and children. J Pediatr Surg 2007;42:234-238.

Soliman R, Zohry G. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Ann Card Anaesth 2016;19:606-613.

Sun WF, Dong ZF, Gong K, Zhang GP, Cui T, Xia YD. Transcatheter closure with use of the SHSMA Occluder in 180 patients with congenital heart defects: Preliminary results. Tex Heart Inst J 2010;37:531-537.

Valente AM, Rhodes JF. Current indications and contraindications for transcatheter atrial septal defect and patent foramen ovale device closure. Am Heart J 2007;153(4 suppl):81-84.

Verrier ED, Wright IH, Cochran RP, Spiess BD. Changes in cardiovascular surgical approaches to achieve early extubation. J Cardiothorac Vasc Anesth 1995;9(5 suppl 1):10-15.

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;95:1224-1229.

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;121:785-790.

Zhang X, Zhao X, Wang Y. Dexmedetomidine: A review of applications for cardiac surgery during perioperative period. J Anesth 2015;29:102-111.

Zhu P, Sun Y, Yang Q, Qiu F. Intraoperative device closure of atrial septal defects with minimal transthoracic invasion: A single-center experience. Tex Heart Inst J 2013;40:256-260.

Published

2021-03-04

How to Cite

yu, ling- shan, lei, yu- qing, liu, jian- feng, wang, jing, cao, hua, wang, zeng- chun, & chen, qiang. (2021). Analysis of Remifentanil-Based Fast-Track Anesthesia Combined with Dexmedetomidine for Transthoracic Device Closure of Atrial Septal Defect in Pediatric Patients. The Heart Surgery Forum, 24(2), E233-E238. https://doi.org/10.1532/hsf.3429

Issue

Section

Article