This study explored how dexmedetomidine (Dex) influences perioperative hemodynamics and provides organ protection in children with congenital heart disease (CHD) undergoing open-heart surgery with hypothermic cardiopulmonary bypass. Ninety pediatric patients were randomly divided into three groups (n = 30 each): group C received 0.9% saline at 0.2 μg/kg/hour, group D1 received Dex at 0.2 μg/kg/hour, and group D2 received Dex at 0.4 μg/kg/hour. Anesthesia induction was performed using fentanyl, propofol, and 1% sevoflurane. Hemodynamic variables were recorded from before induction (T0) to 30 minutes after extubation (T7). Cerebral oxygen extraction and arteriovenous oxygen differences in the internal jugular vein were calculated using the Fick principle. Serum biomarkers for cardiac, cerebral, and renal injury were measured with enzyme-linked immunosorbent assays. The incidence of acute kidney injury (AKI) was determined by serum creatinine levels. Tracheal extubation times, postoperative pain scores, and emergence agitation scores were also assessed.
Both Dex groups (D1 and D2) demonstrated more stable hemodynamics, lower cardiac and cerebral injury markers, and shorter extubation times compared with the control group. No significant differences were found among the groups in blood urea nitrogen, neutrophil gelatinase-associated lipocalin levels, or AKI incidence. Dex administration also reduced the occurrence of tachycardia, nausea, vomiting, moderate agitation, and FLACC pain scores. Moreover, the higher Dex dose (0.4 μg/kg/hour) was associated with a further reduction in fentanyl and dopamine requirements relative to the lower dose (0.2 μg/kg/hour). Dexmedetomidine anesthesia effectively preserves hemodynamic stability and reduces organ injury in children with congenital heart disease.
