Dexmedetomidine and magnesium sulfate effective in preventing junctional ectopic tachycardia after cardiac surgery in pediatric patients

A recent study showed that dexmedetomidine, either on its own or combined with magnesium sulfate (MgSO4), played a therapeutic role in preventing junctional ectopic tachycardia (JET) in pediatric patients following congenital heart surgery. This study’s findings were published in the Paediatric Anaesthesia journal.

A total of 120 children under the age of 5, who were scheduled for corrective acyanotic cardiac surgeries, were randomly divided into three groups. The first group, Group MD (Dexmedetomidine-MgSO4 group), received dexmedetomidine 0.5 μg/kg intravenously over a period of 20 minutes after induction. This was followed by an infusion of 0.5 μg/kg/h for 72 hours, along with a 50 mg/kg bolus of MgSO4 upon aortic cross-clamp release. The administration of MgSO4 continued for 72 hours postoperatively at a dose of 30 mg/kg/day. The second group, Group D (the dexmedetomidine group), received the same dexmedetomidine as the MD group, but instead of MgSO4, they were given normal saline. The third group, Group C (control group), received normal saline instead of dexmedetomidine and MgSO4. The primary outcome of the study was the incidence of JET, while the secondary outcomes included monitoring hemodynamic parameters, extubation time, ionized Mg levels, vasoactive-inotropic score, duration of stay in the post-cardiac care unit (PCCU) and hospital, as well as perioperative complications.

Group MD and Group D demonstrated a significant reduction in the incidence of JET when compared to Group C. During rewarming and in the ICU, Group MD exhibited significantly higher levels of ionized Mg compared to Groups D and C. Throughout the surgery and in the ICU, Group MD displayed a better hemodynamic profile in comparison to Group D and Group C. The predictive indexes were significantly more favorable in Group MD than in Groups D and C including factors such as extubation time, PCCU, and hospital stay.

The above study demonstrated that dexmedetomidine, whether administered alone or in conjunction with MgSO4, demonstrated efficacy in preventing JET in pediatric patients who underwent congenital heart surgery.