Leo Leung1,2, Lik Hang N Lee3, Bobby Lee4,5, Anthony Chau4,5, Erica H Z Wang6,7,8. 1. Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada. 2. Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada. 3. Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 4. Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada. 5. Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada. 6. Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada. ewang@providencehealth.bc.ca. 7. Department of Pharmacy, St. Paul's Hospital, Vancouver, BC, Canada. ewang@providencehealth.bc.ca. 8. Department of Pharmacy, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, Vancouver, BC, V6Z1Y6, Canada. ewang@providencehealth.bc.ca.
Abstract
PURPOSE: The off-label use of dexmedetomidine beyond the monograph-recommended maximum dose of 0.7 µg·kg-1·hr-1 is common in postoperative cardiac surgical units; however, limited data exist on the association of higher doses and adverse hemodynamic effects. We sought to compare the rate of hypotension or bradycardia in cardiac surgery patients receiving peak infusion doses below and above 0.7 µg·kg-1·hr-1 for any indication or duration. METHODS: In this historical cohort study, we reviewed all patients who received dexmedetomidine infusion after cardiac surgery between June 2013 and July 2017 at a single centre. Regardless of the duration of exposure at the peak infusion dose, patients were categorized into high- or standard-dose groups using 0.7 µg·kg-1·hr-1 as the cutoff value. We compared rates of the primary composite outcome of hypotension or bradycardia, and secondary outcomes (i.e., arrhythmia and hyperglycemia) between groups using the two-proportion z test. Exploratory regression models were fitted to adjust for potential confounders. RESULTS: The median [interquartile range (IQR)] peak infusion dose was 1.0 [1.0-1.4] µg·kg-1·hr-1 in the high-dose group (N = 121) and 0.5 [0.4-0.7] µg·kg-1·hr-1 in the standard-dose group (N = 124). The rates of the primary composite outcome were 73% and 65%, respectively (absolute risk difference, 8%; 95% confidence interval, -3 to 20; P = 0.17). There was no significant difference in primary or secondary outcomes between groups. CONCLUSION: There was a high overall rate of hypotension or bradycardia in patients receiving dexmedetomidine after cardiac surgery; infusion rates below or above 0.7 µg·kg-1·hr-1 had similar rates of adverse hemodynamic events.
PURPOSE: The off-label use of dexmedetomidine beyond the monograph-recommended maximum dose of 0.7 µg·kg-1·hr-1 is common in postoperative cardiac surgical units; however, limited data exist on the association of higher doses and adverse hemodynamic effects. We sought to compare the rate of hypotension or bradycardia in cardiac surgery patients receiving peak infusion doses below and above 0.7 µg·kg-1·hr-1 for any indication or duration. METHODS: In this historical cohort study, we reviewed all patients who received dexmedetomidine infusion after cardiac surgery between June 2013 and July 2017 at a single centre. Regardless of the duration of exposure at the peak infusion dose, patients were categorized into high- or standard-dose groups using 0.7 µg·kg-1·hr-1 as the cutoff value. We compared rates of the primary composite outcome of hypotension or bradycardia, and secondary outcomes (i.e., arrhythmia and hyperglycemia) between groups using the two-proportion z test. Exploratory regression models were fitted to adjust for potential confounders. RESULTS: The median [interquartile range (IQR)] peak infusion dose was 1.0 [1.0-1.4] µg·kg-1·hr-1 in the high-dose group (N = 121) and 0.5 [0.4-0.7] µg·kg-1·hr-1 in the standard-dose group (N = 124). The rates of the primary composite outcome were 73% and 65%, respectively (absolute risk difference, 8%; 95% confidence interval, -3 to 20; P = 0.17). There was no significant difference in primary or secondary outcomes between groups. CONCLUSION: There was a high overall rate of hypotension or bradycardia in patients receiving dexmedetomidine after cardiac surgery; infusion rates below or above 0.7 µg·kg-1·hr-1 had similar rates of adverse hemodynamic events.
Authors: Pratik P Pandharipande; Brenda T Pun; Daniel L Herr; Mervyn Maze; Timothy D Girard; Russell R Miller; Ayumi K Shintani; Jennifer L Thompson; James C Jackson; Stephen A Deppen; Renee A Stiles; Robert S Dittus; Gordon R Bernard; E Wesley Ely Journal: JAMA Date: 2007-12-12 Impact factor: 56.272
Authors: Stephen Su Yang; Charles Gelinas; Edmund Yim; Mandy M J Li; Kenneth Kardash; Michelle Zhang; Jed Lipes Journal: Can J Anaesth Date: 2022-10-12 Impact factor: 6.713