caa a22 4500 445825383 CHVBK 20180317145257.0 cr unu---uuuuu 170323e20111201xx s 000 0 eng 10.1007/s00246-011-0092-8 doi (NATIONALLICENCE)springer-10.1007/s00246-011-0092-8 Dexmedetomidine: Applications for the Pediatric Patient With Congenital Heart Disease [Elektronische Daten] [Joseph Tobias, Punkaj Gupta, Aymen Naguib, Andrew Yates] This study aimed to provide a general description of the cardiovascular and hemodynamic effects of dexmedetomidine and an evidence-based review of the literature regarding its use in infants and children with congenital heart disease (CHD). A computerized bibliographic search of the literature on dexmedetomidine use in infants and children with CHD was performed. The cardiovascular effects of dexmedetomidine have been well studied in animal and adult human models. Adverse cardiovascular effects include occasional episodes of bradycardia, with rare reports of sinus pause or cardiac arrest. Both hypotension and hypertension also have been reported. The latter is related to peripheral α2B agonism leading to vasoconstriction. No adverse effects on the pulmonary vasculature have been noted even in patients with preexisting pulmonary hypertension. Although there are no direct effects on myocardial function, decreased cardiac output may result from changes in heart rate or increases in afterload. Although not currently Food and Drug Administration (FDA)-approved for the pediatric population, findings have shown dexmedetomidine to be effective in various clinical scenarios of patients with CHD including sedation during mechanical ventilation, prevention of procedure-related anxiety, prevention of emergence delirium and shivering after anesthesia, and treatment of withdrawal. Although dexmedetomidine may have limited utility for painful or invasive procedures, preliminary data suggest that the addition of ketamine to the regimen may offer benefits. When used during the perioperative period, additional benefits include blunting of the sympathetic stress response with a reduction of endogenous catecholamine release, a decrease in intraoperative anesthetic requirements, and a limitation of postoperative opioid requirements. Springer Science+Business Media, LLC, 2011 Congenital heart disease nationallicence Dexmedetomidine nationallicence Sedation nationallicence Tobias Joseph Department of Anesthesiology and The Heart Center, Nationwide Children's Hospital and Ohio State University, 43205, Columbus, OH, USA aut Gupta Punkaj Division of Pediatric Cardiac Critical Care, Arkansas Children's Hospital, Little Rock, AR, USA aut Naguib Aymen Department of Anesthesiology and The Heart Center, Nationwide Children's Hospital and Ohio State University, 43205, Columbus, OH, USA aut Yates Andrew Department of Pediatrics, Divisions of Pediatric Cardiology and Pediatric Critical Care, Nationwide Children's Hospital and Ohio State University, 43205, Columbus, OH, USA aut Pediatric Cardiology Springer-Verlag 32/8(2011-12-01), 1075-1087 0172-0643 32:8<1075 2011 32 246 https://doi.org/10.1007/s00246-011-0092-8 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00246-011-0092-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tobias Joseph Department of Anesthesiology and The Heart Center, Nationwide Children's Hospital and Ohio State University, 43205, Columbus, OH, USA aut NATIONALLICENCE 700 1- Gupta Punkaj Division of Pediatric Cardiac Critical Care, Arkansas Children's Hospital, Little Rock, AR, USA aut NATIONALLICENCE 700 1- Naguib Aymen Department of Anesthesiology and The Heart Center, Nationwide Children's Hospital and Ohio State University, 43205, Columbus, OH, USA aut NATIONALLICENCE 700 1- Yates Andrew Department of Pediatrics, Divisions of Pediatric Cardiology and Pediatric Critical Care, Nationwide Children's Hospital and Ohio State University, 43205, Columbus, OH, USA aut NATIONALLICENCE 773 0- Pediatric Cardiology Springer-Verlag 32/8(2011-12-01), 1075-1087 0172-0643 32:8<1075 2011 32 246 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer