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Intensive Care Unit Analgosedation After Cardiac Surgery in Children with Williams Syndrome : a Matched Case–Control Study

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Abstract

Objective

Cardiovascular abnormalities are common in patients with Williams syndrome and frequently require surgical intervention necessitating analgesia and sedation in a population with a unique neuropsychiatric profile, potentially increasing the risk of adverse cardiac events during the perioperative period. Despite this risk, the overall postoperative analgosedative requirements in patients with WS in the cardiac intensive care unit have not yet been investigated. Our primary aim was to examine the analgosedative requirement in patients with WS after cardiac surgery compared to a control group. Our secondary aim was to compare the frequency of major ACE and mortality between the two groups.

Design

Matched case–control study.

Setting

Pediatric CICU at a Tertiary Children’s Hospital.

Patients

Patients with WS and age-matched controls who underwent cardiac surgery and were admitted to the CICU after cardiac surgery between July 2014 and January 2021.

Interventions

None.

Measurements and Main Results

Postoperative outcomes and total doses of analgosedative medications were collected in the first six days after surgery for the study groups. Median age was 29.8 (12.4–70.8) months for WS and 23.5 (11.2–42.3) months for controls. Across all study intervals (48 h and first 6 postoperative days), there were no differences between groups in total doses of morphine equivalents (5.0 mg/kg vs 5.6 mg/kg, p = 0.7 and 8.2 mg/kg vs 10.0 mg/kg, p = 0.7), midazolam equivalents (1.8 mg/kg vs 1.5 mg/kg, p = 0.4 and 3.4 mg/kg vs 3.8 mg/kg, p = 0.4), or dexmedetomidine (20.5 mcg/kg vs 24.4 mcg/kg, p = 0.5 and 42.3 mcg/kg vs 39.1 mcg/kg, p = 0.3). There was no difference in frequency of major ACE or mortality.

Conclusions

Patients with WS received similar analgosedative medication doses compared with controls. There was no significant difference in the frequency of major ACE (including cardiac arrest, extracorporeal membrane oxygenation, and surgical re-intervention) or mortality between the two groups, though these findings must be interpreted with caution. Further investigation is necessary to elucidate the adequacy of pain/sedation control, factors that might affect analgosedative needs in this unique population, and the impact on clinical outcomes.

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Funding

No financial support was required for this study.

Author information

Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, 2835 Brandywine Road, Suite 400, 30341, Atlanta, GA, Georgia

    Marcos Mills

  2. Division of Pediatric Cardiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA

    Claudia Algaze, Chloe Journel, Geovanna Suarez, Kirstie Lechich & M. David Kwiatkowski

  3. Division of Pediatric Cardiac Anesthesia, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA

    Alexander R. Schmidt

  4. Division of Pediatric Cardiology, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA

    R. Thomas Collins

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  1. Marcos Mills
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  2. Claudia Algaze
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Contributions

MM, CA, RC designed the study and wrote the main manuscript. CA performed the statistical analysis. CJ, KL, and GS collected the data. AS and DK made significant revisions to the the initial manuscript. All authors reviewed the manuscript.

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Correspondence to Marcos Mills.

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Mills, M., Algaze, C., Journel, C. et al. Intensive Care Unit Analgosedation After Cardiac Surgery in Children with Williams Syndrome : a Matched Case–Control Study. Pediatr Cardiol 45, 107–113 (2024). https://doi.org/10.1007/s00246-023-03321-8

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  • DOI: https://doi.org/10.1007/s00246-023-03321-8

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