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Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 153-155

Dexmedetomidine in a patient with unrepaired congenital cyanotic heart disease

1 Department of Cardiac Anesthesia, SGRRIM and HS, Dehradun, Uttarakhand, India
2 Department of Anesthesiology, SGRRIM and HS, Dehradun, Uttarakhand, India
3 Department of Anaesthesia, AIIMS, Rishikesh, Uttarakhand, India

Correspondence Address:
Dr. Nishith Govil
Department of Anesthesiology, SGRRIM and HS, Dehradun - 248 001 Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/TheIAForum.TheIAForum_27_20

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The challenges in a patient with unrepaired congenital cyanotic heart disease (CCHD) requiring controlled hypotension are to prevent a further increase in the right-to-left (R-L) shunt by maintaining systemic vascular resistance, controlling pulmonary vascular resistance (PVR), decreasing oxygen consumption, and preventing arrhythmia and hypovolemia. To the best of our knowledge, combination of ketamine and dexmedetomidine has not been used in a patient with unrepaired CCHD to keep hemodynamic stable, preventing reversal of shunt and arrhythmias while providing controlled hypotension. The rationale of using combination of intravenous ketamine and dexmedetomidine is to counteract sympathoinhibitory effects of dexmedetomidine with the cardiostimulatory effects of ketamine, thus maintaining a stable hemodynamic in cases with R-L shunt. Another benefit in CCHD is that dexmedetomidine decreases the incidence of arrhythmia intraoperatively and decreases dynamic response of the right ventricular outflow tract induced by pain, thus decreasing R-L shunt. Dexmedetomidine encourages protective mechanisms during hypoxia as in patients with CCHD by lowering anti-ischemic responses such as lactate production and a modest decrease in the PVR. Dexmedetomidine provides controlled hypotension and uneventful recovery due to its lowering of stress response of surgery and opioid sparing effect and decreases the incidence of emergence agitation and postoperative nausea and vomiting.

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