The Role of Dexmedetomidine as Myocardial Protector in Pediatric Cardiac Surgery Total Correction of Tetralogy of Fallot
Status:
Recruiting
Trial end date:
2023-06-01
Target enrollment:
Participant gender:
Summary
Congenital heart disease (CHD) is the most common congenital abnormality found in newborns
with Tetralogy of Fallot (TOF) being the most common cyanotic CHD. Total correction of TOF
was performed using a cardiopulmonary bypass (CPB) machine. However, the use of CPB has a
negative effect that causes inflammation and myocardial injury. Myocardial protection in
patients undergoing total correction of TOF surgery is more difficult than other cyanotic CHD
due to a hypertrophic right ventricular condition. Dexmedetomidine (DEX) is a selective α-2
adrenergic, which has major effects including hypnosis, sedation, and analgesia as well as
cardiovascular effects. The sedation is induced by stimulating the α-2 adrenergic receptor in
the locus coeruleus (LC) in the pons cerebri. DEX also increases the level of GABA and
Galanin and reduces endogenous norepinephrine. The lower level of endogenous norepinephrine
decreases the afterload of the ventricles, increases cardiac output, and reduces myocardial
injury as a result. Furthermore, the peripheral effects of DEX can reduce myocardial
ischemia-reperfusion (MIR) by inhibiting NF-кB pathway activation and reducing the number of
pro-inflammatory cytokines released. Thus, the administration of DEX can prevent myocardial
necrosis and apoptosis, also reducing reperfusion injury when using CPB machines. Research
related to the effectiveness of administering DEX as a myocardial protector in classic TOF
patients undergoing elective total correction cardiac surgery in Indonesia is less reported.
The aim of this study is to determine the effectiveness of DEX as myocardial protector in
classic TOF patients undergoing elective total correction cardiac surgery.
Phase:
Phase 2/Phase 3
Details
Lead Sponsor:
National Cardiovascular Center Harapan Kita Hospital Indonesia