Dexmedetomidine infusion as an adjunct anesthetic for tetralogy of fallot repair during a pediatric cardiac mission trip in Jamaica: a case report.

Dexmedetomidine was used as an adjunct anesthetic for an infant with tetralogy of Fallot (TOF). who underwent complete surgical repair during a mission trip in Jamaica. Anesthetic maintenance was achieved with the concomitant use of dexmedetomidine and remifentanil infusions, as well as inhalational sevoflurane. The dexmedetomidine infusion ranged from 0.3 to 0.5 µg/kg/h and the remifentanil infusion ranged from 0.5 to 2 µg/kg/min, with end-tidal sevoflurane ranging from 0.8% to 6%. The continuous infusion of dexmedetomidine in a complex pediatric cardiac surgical patient provides sedation, decreases the need for narcotics and volatile agents, while also providing improved hemodynamic stability. This report includes a review of the anatomy and pathophysiology of tetralogy of Fallot, medical and surgical treatments, anesthetic management, as well as global health issues involved in caring for complex cardiac patients in this underserved population. The expertise and dedication of medical mission professionals ensures that children in developing Caribbean countries receive life-saving heart surgery that would otherwise not be available. Collaboration between pediatric cardiac surgery programs in the United States and developing programs in the Caribbean is vital to the future of a self-sustaining cardiac program that will provide the knowledge and resources to care for these complex cardiac patients.