The effect of intraoperative dexmedetomidine on acute kidney injury after pediatric congenital heart surgery A prospective randomized trial

Abstract

Background: Dexmedetomidine has been reported to have a renal protective effect after adult open heart surgery. The authors hypothesized that intraoperative infusion of dexmedetomidine would attenuate the decrease in renal function after pediatric open heart surgery. Methods: Twenty-nine pediatric patients (1-6 years) scheduled for atrial or ventricular septal defect repair were randomly assigned to receive either continuous infusion of normal saline (control group, n=14) or dexmedetomidine (a bolus dose of 0.5 mu g/kg and then an infusion of 0.5 mu g/kg/h) (dexmedetomidine group, n=15) from anesthesia induction to the end of cardiopulmonary bypass. Serum creatinine (Scr) was measured before surgery (T0), 10minutes after anesthesia induction (T1), 5minutes after cardiopulmonary bypass weaning (T2), 2hours after T2 (T3), and after postoperative day 1 (POD1) and postoperative day 2 (POD2) and estimated glomerular filtration rates (eGFRs) were calculated. Renal biomarkers were measured at T1, T2, and T3. Acute kidney injury (AKI) was defined as an absolute increase in Scr of >= 0.3mg/dL or a percent increase in Scr of >= 50%. Results: The incidence of AKI during the perioperative period was significantly higher in the control group than in the dexmedetomidine group (64% [9/14] vs 27% [4/15], P=.042). eGFR was significantly lower in the control group than in the dexmedetomidine group at T2 (72.6+/-15.1 vs 83.9+/-13.5, P=.044) and T3 (73.4+/-15.4 vs 86.7+/-15.9, P=.03). Conclusion: Intraoperative infusion of dexmedetomidine may reduce the incidence of AKI and suppress post-bypass eGFR decline.