Effect of Prophylactic Amiodarone Versus Dexmedetomidine on Reducing the Frequency of Postoperative Junctional Ectopic Tachycardia after Pediatric Open Heart Surgery

Abstract

Objective: To compare the effect of prophylactic amiodarone versus dexmedetomidine on reducing the frequency of post-surgical junctional ectopic tachycardia (JET) following pediatric open heart surgery.

Study Design: Randomized controlled trial study.

Place and Duration of Study: This study was conducted at the Pediatric Cardiology Intensive Care Unit (PCICU), National Institute of Cardiovascular Diseases, Karachi, Pakistan from May 2021 to April 2023.

Materials and Methods: Children of both genders aged between 1 to 12 years and planned to undergo cardiopulmonary bypass surgery were included. Children in amiodarone group (n=50) were given amiodarone at the time of induction of anaesthesia as 5-10 mcg per kg per minute (depending upon the hemodynamic) and continued for the next 48 hours. In the dexmedetomidine group (n=50), children were administered dexmedetomidine at the time of induction of anaesthesia as 0.2-0.5 mcg per kg per hour (depending upon the hemodynamics) and continued for the next 48 hours. The frequency of JET was noted.

Results: In a total of 100 children undergoing cardiopulmonary bypass surgery, 61 (61.0%) were boys while the mean age was 6.4±4.8 years. The mean cardiopulmonary bypass and aortic cross clamp time were 86.7±34.5 minutes and 45.9±24.1 minutes respectively. The most frequent types of CHDs were ventricular septal defect (VSD) and tetralogy of fallot (TOF) noted in 38 (38.0%) and 26 (26.0%) children respectively. Overall, frequency of JET was noted in 18 (18.0%) children. The frequency of JET was 5 (10.0%) children in amiodarone group versus 13 (26.0%) in the dexmedetomidine group (p=0.0373).

Conclusion: Post-surgical JET was found to be a common observation among children undergoing cardiopulmonary bypass surgery. Prophylactic amiodarone resulted in significantly less frequency of JET when compared to dexmedetomidine.