PMID- 34966972
OWN - NLM
STAT- MEDLINE
DCOM- 20220407
LR  - 20220921
IS  - 1496-8975 (Electronic)
IS  - 0832-610X (Linking)
VI  - 69
IP  - 3
DP  - 2022 Mar
TI  - The safety of high-dose dexmedetomidine after cardiac surgery: a historical 
      cohort study.
PG  - 323-332
LID - 10.1007/s12630-021-02167-z [doi]
AB  - PURPOSE: The off-label use of dexmedetomidine beyond the monograph-recommended 
      maximum dose of 0.7 microg.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 
      microg.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 microg.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] microg.kg(-1).hr(-1) 
      in the high-dose group (N = 121) and 0.5 [0.4-0.7] microg.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 microg.kg(-1).hr(-1) had similar rates of adverse 
      hemodynamic events.
CI  - (c) 2021. Canadian Anesthesiologists' Society.
FAU - Leung, Leo
AU  - Leung L
AD  - Department of Pharmacy, Vancouver General Hospital, Vancouver, BC, Canada.
AD  - Faculty of Pharmaceutical Sciences, The University of British Columbia, 
      Vancouver, BC, Canada.
FAU - Lee, Lik Hang N
AU  - Lee LHN
AD  - Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
FAU - Lee, Bobby
AU  - Lee B
AD  - Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada.
AD  - Department of Anesthesiology, Pharmacology & Therapeutics, The University of 
      British Columbia, Vancouver, BC, Canada.
FAU - Chau, Anthony
AU  - Chau A
AD  - Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada.
AD  - Department of Anesthesiology, Pharmacology & Therapeutics, The University of 
      British Columbia, Vancouver, BC, Canada.
FAU - Wang, Erica H Z
AU  - Wang EHZ
AUID- ORCID: 0000-0002-8065-2556
AD  - Faculty of Pharmaceutical Sciences, The University of British Columbia, 
      Vancouver, BC, Canada. ewang@providencehealth.bc.ca.
AD  - Department of Pharmacy, St. Paul's Hospital, Vancouver, BC, Canada. 
      ewang@providencehealth.bc.ca.
AD  - Department of Pharmacy, St. Paul's Hospital, Providence Health Care, 1081 Burrard 
      Street, Vancouver, BC, V6Z1Y6, Canada. ewang@providencehealth.bc.ca.
LA  - eng
PT  - Journal Article
TT  - Innocuite de la dexmedetomidine a forte dose apres une chirurgie cardiaque : une 
      etude de cohorte historique.
DEP - 20211229
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 0 (Hypnotics and Sedatives)
RN  - 67VB76HONO (Dexmedetomidine)
SB  - IM
MH  - *Cardiac Surgical Procedures
MH  - Cohort Studies
MH  - *Dexmedetomidine/adverse effects
MH  - Humans
MH  - Hypnotics and Sedatives/adverse effects
MH  - *Hypotension/chemically induced/epidemiology
OTO - NOTNLM
OT  - Adverse effects
OT  - Cardiac surgery
OT  - Critically ill
OT  - Dexmedetomidine
OT  - High dose
EDAT- 2021/12/31 06:00
MHDA- 2022/04/08 06:00
CRDT- 2021/12/30 05:47
PHST- 2021/05/25 00:00 [received]
PHST- 2021/10/25 00:00 [accepted]
PHST- 2021/08/23 00:00 [revised]
PHST- 2021/12/31 06:00 [pubmed]
PHST- 2022/04/08 06:00 [medline]
PHST- 2021/12/30 05:47 [entrez]
AID - 10.1007/s12630-021-02167-z [pii]
AID - 10.1007/s12630-021-02167-z [doi]
PST - ppublish
SO  - Can J Anaesth. 2022 Mar;69(3):323-332. doi: 10.1007/s12630-021-02167-z. Epub 2021 
      Dec 29.