Prophylactic Dexmedetomidine Reduces Junctional Ectopic Tachycardia and Facilitates Postoperative Recovery in Pediatric Cardiac Surgery: A Systematic Review and Meta-Analysis of Prospective Trials.

OBJECTIVE

To evaluate the efficacy and safety of prophylactic dexmedetomidine in preventing Junctional Ectopic Tachycardia (JET) and its impact on postoperative recovery in pediatric congenital heart surgery, restricting analysis to prospective trials.

METHODS

We systematically searched PubMed, Scopus, and CENTRAL through October 16, 2025, for prospective randomized and quasi-randomized trials. Retrospective cohorts were excluded. The primary outcome was postoperative JET incidence. Secondary outcomes included mechanical ventilation duration, ICU length of stay (LOS), Vasoactive-Inotropic Score (VIS), and safety. Data were synthesized using random-effects models and certainty of evidence was assessed using the GRADE framework.

RESULTS

Five prospective trials (n = 639) met the inclusion criteria. Prophylactic dexmedetomidine was associated with a significant reduction in postoperative JET incidence (OR 0.37; 95% CI 0.23-0.58; p < 0.0001; I2 = 0%), supported by moderate-certainty evidence. For secondary outcomes, pooled analyses suggested reductions in mechanical ventilation (MD -4.80 h) and ICU LOS (MD -19.83 h), but these were characterized by substantial clinical heterogeneity and low to very-low certainty of evidence. A significant reduction in VIS emerged only in the sensitivity analysis; these findings remain hypothesis-generating. No significant differences were observed for mortality or hypotension.

CONCLUSIONS

In prospective pediatric cardiac surgery trials, prophylactic dexmedetomidine was associated with reduced postoperative JET, supported by moderate-certainty evidence. While dexmedetomidine may help facilitate earlier recovery, its impact on secondary outcomes remains suggestive rather than definitive due to low evidence certainty. Future large-scale, multicenter randomized trials are required to confirm if these potential benefits translate into consistent clinical improvements.