Dexmedetomidine and Outcomes after Airway Reconstruction

Abstract

Objective: To examine the outcomes of children receiving dexmedetomidine (Dex) as a primary sedation agent after single-stage airway reconstruction.

Method: Retrospective analysis of a prospective case cohort protocol using Dex as a primary sedation agent vs ketamine/midazolam/morphine in single-stage airway reconstruction at a tertiary care children’s hospital between November 2005 and January 2012. Primary outcomes included length of intubation/PICU admission. Secondary outcomes included the need for polypharmacy and complication rates.

Results: Forty-eight patients were included; 28 received Dex sedation. Median age was 18.0 months (2-131). Age and weight were similar between the groups, as was length of intubation (9 days Dex vs 8 days no-Dex, P = .46). There were no statistical differences between lengths of PICU stay after extubation (4 days Dex vs 3.5 days no-Dex, P = .83), lengths of stay after extubation (7 days Dex vs 7.5 days no-Dex, P = .122), percentage of polypharmacy days (81.6% Dex vs 64.6% no-Dex, P = .20), reintubation rates (20% Dex vs 14% no-Dex, P = .60), withdrawal rates (46% Dex vs 45% no-Dex, P = .92), or rates of airway infection (36% Dex vs 25% no-Dex, P = .43).

Conclusion: Dexmedetomidine sedation does not decrease the lengths of intubation or PICU admission, the need for polypharmacy, or the rates of reintubation, withdrawal, and infection after single-stage airway reconstruction in children. Although surgical success can be expected in greater than 90% of these patients, the optimal postoperative sedation management remains challenging.