Using of dexmedetomidine in term neonates with hypoxic-ischemic encephalopathy
Journal Title: Медичні перспективи - Year 2019, Vol 24, Issue 2
Abstract
The negative impacts of standard pharmacologic sedative agents suggest that alternative agents should be investigated. Dexmedetomidine could be the new option for sedation in newborns with hypoxic-ischemic encephalopathy requiring mechanical ventilation. The aim – to determine the impact of dexmedetomidine and other sedatives on the cerebral blood flow and outcomes of hypoxic-ischemic encephalopathy in term neonates. Data of 205 term infants with hypoxic-ischemic encephalopathy by Sarnat scale stage II-III were collected during ≤72 hours of life. The infants were divided using a simple open randomization by pharmacological sedative agents during mechanical ventilation into dexmedetomidine group (n=46) and the control group (n=159), which included morphine, sodium oxybutyrate, and diazepam in standard recommended doses. A comparative analysis of the effect of dexmedetomidine and other drugs on cerebral perfusion and outcomes of hypoxic-ischemic encephalopathy was performed. A significant difference between groups in days of trachea extubation (p=0.022) was found; the chance for babies to be extubated before the 7th day of treatment was significantly higher in the dexmedetomidine group 68% versus 33% in the control group (p=0.018) with HR 0.48 (95% CI 0.27-0.86, p=0.011). Also, the NIRS index rScO2 differed significantly between the studied and control groups on the 1st day of treatment (65% versus 79%, p=0.012) and on the 2nd day of treatment (74% versus 81%, p=0.035). Mean arterial pressure was higher in the dexmedetomidine group compared to the control group – (58 [51-65] mm Hg versus 53 [46-60] mm Hg, p<0.001), with a lower dose of dobutamine (EV -1.87, 95% CI from -3.25 to -0.48, p=0.009). In the dexmedetomidine group, the rate of seizures was significantly lower on the 1st day of observation (4.3% versus 48.3%, p <0.001); the incidence of unfavorable outcome sueh as cerebral leukomalacia was also 7 times lower in the dexmedetomidine group compared to the control group (2.2% versus 15.1%, p=0.018). Dexmedetomidine is a safe sedative agent with a stable hemodynamic profile, without adverse influence on cerebral perfusion and possible neuroprotective effects in term infants with HIE, as addition to standard therapeutic hypothermia.
Authors and Affiliations
D. Surkov
Keywords
Related Articles
- EP ID EP595270
- DOI 10.26641/2307-0404.2019.2.170123
- Views 77
- Downloads 0
Биостатистический анализ результатов лечения бактериальных абсцессов печени с использованием малоинвазивных методов и открытых хирургических вмешательств
На сьогоднішній день бактеріальні абсцеси залишаються одними з найтяжчих ускладнень у хірургічній гепатології, для лікування яких використовують як традиційні методи лікування, так і малоінвазивні методики. Тому використ...
Prerequisites for the development of forecasting system of cerebrovascular diseases development in the patients with vibration disease caused by the actions of the whole-body vibration in the post-exposure period
The health of the working population is an important characteristic of the economic and social state of the country. Occupational diseases according to WHO is the cause of 1.7 million deaths in the world. The third place...
Порушення внутрішньосерцевої гемодинаміки у дітей з хронічною ревматичною хворобою серця
С помощью допплерэхокардиографии изучены нарушения внутрисердечной гемодинамики у 44 детей в возрасте от 8 до 17 лет с хронической ревматической болезнью сердца и сформированными митральным, аортальным и комбинированными...
Значення наукових ідей М.І. Пирогова для сучасної організації охорони здоров’я
Эта статья о Николае Ивановиче Пирогове – хирурге и анатоме, выдающемся ученом и воспитателе, основателе полевой хирургии. Он первым изучил на практике военную хирургию и вопросы полевой медицинской администрации,...
Результати клінічної апробації фотодинамічної терапії в комплексному лікуванні гінгівіту, який ускладнює ортодонтичне лікування із застосуванням брекет-систем
Несмотря на высокую эффективность, применение брекет-систем у ортодонтических больных способно провоцировать развитие воспалительных процессов в тканях маргинального пародонта. Целью настоящего исследования стало изучен...