Introduction
Volatile anesthetics have dose-dependent myocardial depressant properties. Thus anesthetists should balance between myocardial stability and adequate depth of anesthesia. Certain adjuvant drugs like dexmedetomedine and midazolam can be used to obtain adequate depth of anesthesia with lower inhalational anesthetic requirement. Thus, avoiding of inhalational anesthetic drugs associated myocardial uppressing affect in such patients with already diseased heart.
Patients and Methods
Seventy children patients with corrective congenital open heart surgery were divided into two groups. One received dexmedetomedine (0.5 μg/Kg/hour) and the other received midazolam infusion (0.05 mg/Kg/hour) as adjuvant to sevoflurane based anesthesia monitored by entropy. End-tidal concentration of sevoflurane, heart rate, MAP, additional fentanyl boluses, extubation time, vomiting and emergence agitation were all recorded.
Results and Conclusion
Sevoflurane end tidal concentration, entropy readings, additional doses of fentanyl, heart rate, MAP, were higher in midazolam group when compared to dexmedetomedine group. Similarly extubation time was longer in midazolam group in comparison to dexmetetomedine group. Emergence agitation score was of no significant value between dexmedetomedine and midazolam group.
Conclusion
with continuous infusion of 0.5 μg/Kg/hour dexmedetomedine during sevoflurane based anesthesia, lower end tidal sevoflurane concentration and entropy readings were noticed in comparison to midazolam infusion. In addition, lowers intraoperative additional opioid requirements and shorter extubation time with more hypotension and bradycardia were observed with dexmedetomedine infusion when compared to midazolam infusion in pediatric congenital corrective cardiac surgery.