Clinical benefits of dexmedetomidine versus propofol in adult intensive care unit patients: a meta-analysis of randomized clinical trials

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

“…In previous studies, 8,9 the incidence of delirium was reduced by roughly a third when dexmedetomidine was used in the ICU for sedating mechanically ventilated patients. Thus, we assumed that the incidence of delirium would be reduced by a third in the dexmedetomidine group in this study.…”

“…31 Dexmedetomidine has been used by intensivists in general practice for sedation in mechanically ventilated ICU patients at an infusion rate from 0·2 to 1·7 μg/kg per h with or without a loading dose ; 7-9 these sedative doses of dexmedetomidine are associated with adverse events, especially hypotension and bradycardia. [7][8][9] In this study, patients were not given a loading dose of dexmedetomidine, and a sub-sedative infusion rate (ie, 0·1 μg/kg per h) was given. The RASS scores were similar between the two groups , indicating that low-dose dexmedetomidine did not produc e signifi cant sedation.…”

“…32 Thirdly, we anticipated that about half of the elective surgical population that require ICU admission would be discharged from the ICU within 24 h; by terminating infusion of dexmedetomidine at 0800 h on the fi rst postoperative day, enough time has elapsed to enable a drug with a terminal elimination half-life of 3·7 h to be cleared from the plasma by the time the patient is discharged from the ICU. 33 Although results of previous studies [7][8][9]31 showed that the occurrence of delirium was reduced in patients randomly assigned t o receive sedative-inducing doses of dexmedetomidine versus an alternative sedative-hypnotic (benzodiazepines or propofol) or analgesic (opiates) in mechanically ventilated patients, it was unclear whether those patients benefi te d through a prophylactic action of dexmedetomidine, or by avoiding delirium-inducing sedatives and analgesics. Our study was placebo-controlled, and a similar proportion of patients received supplemental sedation in both groups, although the total consumed propofol dose was less in the patients who received dexmedetomidine (table 1).…”

“…5 Dexmedetomidine is increasingly used for sedation in mechanically ventilated patients in the intensive care unit (ICU), 6 where its use is associated with a decreased prevalence of delirium when compared with other sedatives. 7,8 However, in each of these delirium-sparing studies, [7][8][9] dexmedetomidine was compared with an active sedative drug that modulates the γ-aminobutyric-acid type A (GABA A ) receptors. These modulators of GABA A receptors, exemplifi ed by benzodiazepines, could increase the prevalence of delirium.…”

Post-Operative Delirium in the Elderly: Diagnosis, Risk Factors and Prevention

“…Dexmedetomidine, a selective α-2 adrenergic agonist, has been proven to decrease the incidence of delirium (68,69). A RCT study including 700 patients suggest that prophylactic lowdose dexmedetomidine significantly decrease the risk of POD in patients over 65 years old (68).…”