Analgesic and Sedative Effect of Fentanyl Versus Dexmedetomidine Infusion in Post-Operative Mechanically Ventilated Children After Open Abdominal Surgeries

Tanta University54 enrolled

Overview

This study aimed to compare the efficacy and safety of fentanyl versus dexmedetomidine infusion in this population.

Appropriate sedation and analgesia are essential components in the post-operative care of critically ill children in the pediatric intensive care unit (PICU), especially those who need mechanical ventilation. Fentanyl is an opioid analgesic that is 50-100 times more potent than morphine. It is used frequently because of its ability to provide rapid analgesia. A single dose of fentanyl significantly reduced pain behaviors and changes in heart rate. It also increased the growth hormone level. Dexmedetomidine is a highly selective alpha-2 adrenergic agonist with significant sedative and analgesic effects. Some studies have investigated its role in adult and pediatric intensive care, as a primary sedative or a second line following failure of benzodiazepines or opioid sedation, as a bridge for extubation, for substance withdrawal, and to decrease intensive care unit (ICU) delirium.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Analgesic Sedative Fentanyl

Interventions

FentanylDRUG

Patients received fentanyl as a 1 μg/kg bolus over 10 min, followed by a 1-5 μg/kg/hr intravenous infusion after 10-15 minutes.

DexmedetomidineDRUG

Patients received dexmedetomidine as a 1 μg/kg bolus over 10 min, followed by a 0.2-0.7 μg/kg/hr intravenous infusion after 10-15 minutes.

Eligibility

Sex: ALLMin age: 4 YearsMax age: 11 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age from 4 to 11 years. * Both sexes. * Children who required a minimum of 24 hrs of mechanical ventilation following open abdominal surgeries Exclusion Criteria: * Patients with significant congenital anomalies. * Chromosomal abnormalities. * Neurologic conditions prohibiting sedation evaluation. * Neuromuscular diseases. * Those receiving neuromuscular blockers

Outcomes

Primary Outcomes

Weaning eligibility

The time from ventilator weaning eligibility was monitored until discharge.

Time frame: 48 hours postoperatively

Secondary Outcomes

Time from eligibility to extubation

Time from eligibility to extubation was monitored until discharge.

Time frame: 60 min postoperatively

Mean arterial pressure

Mean arterial pressure was continuously monitored and recorded at baseline and 2, 5, 10, 15, 30 minutes, 2, 6, 12, 24, and 48 hrs post-infusion initiation.

Time frame: 48 hours post-infusion initiation

Heart rate

Heart rate was continuously monitored and recorded at baseline and 2, 5, 10, 15, 30 minutes, 2, 6, 12, 24, and 48 hrs post-infusion initiation.