Dexmedetomidine

Soares, Luiz Guilherme L; Naylor, Cláudia; Martins, Maurı́lio A; Peixoto, Geralda

doi:10.1016/s0885-3924(02)00423-2

Cited by 35 publications

(5 citation statements)

References 9 publications

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“…Dexmedetomidine was discontinued for one patient, due to no perceived benefit; and for 3 patients with intolerable side effects (2 hypotension, 1 dyspnea) as documented in the patient’s charts. No loading doses were used; which differs from some case reports [ 15 , 16 ]. No patient exceeded the maximum ICU dexmedetomidine infusion rate of 1.4 mcg/kg/h, which was consistent with published case reports in adults.…”

Section: Resultsmentioning

confidence: 99%

Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study

Yu,

Schellenberg,

Alleyne

2023

PLoS ONE

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Patients seen by the palliative care team often have difficult and intractable symptoms. The current standard of practice to manage these symptoms is the deeply sedating midazolam continuous subcutaneous infusion for patients who are expected to expire within hours to days. Dexmedetomidine provides sedation but lacks evidence in palliative care use. This study describes continuous subcutaneous infusion of dexmedetomidine’s effect on refractory pain and delirium. Retrospective, observational chart review and conducted in accordance with SQUIRE (quality improvement study). Twenty adult patients (18 years of age or older) with metastatic cancer disease admitted to three palliative complex care units of Fraser Health who received continuous subcutaneous infusion of dexmedetomidine between January 2017 to August 31, 2019. Average length of dexmedetomidine use was 9 days (1/3 length of stay). Eight of the 13 patients with pain symptoms exhibited an overall decline in pain. Four of the 6 patients with delirium had an initial decrease in delirium, but it did not last beyond the first day. Despite progressive clinical deterioration, adjunctive medications decreased or remained the same for 53% of as needed medications and 65% for regularly scheduled medications. Forty-five percent of patients had ≥50% days of rousable sedation. Hypotension occurred in 85% of patients. Dexmedetomidine provided benefit in managing intractable pain while allowing patients to remain rousable, but only had a short effect on delirium symptoms.

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Section: Resultsmentioning

confidence: 99%

Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study

Yu,

Schellenberg,

Alleyne

2023

PLoS ONE

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“…Published 20 years ago, the first report on the use of dexmedetomidine in palliative care depicted its applicability in dying cancer patients with pain, anxiety, and symptoms compatible with side effects from the ongoing symptom management [27]. A decade later, a case report described the drug as a safe adjuvant agent for analgesia in patients with intractable cancer pain [8].…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…Already the first report concerning dexmedetomidine for symptom relief late in the palliative care trajectory described the use of continuous infusions [27]. While intravenous administration previously was preferred, the proven rapid and efficient absorption of subcutaneously administered dexmedetomidine made subcutaneous drug delivery a feasible alternative [8,10,11,17].…”

Section: Comparison With Previous Workmentioning

confidence: 99%

“…However, the evidence base for its use in this group of patients is still limited [26]. For adults, case reports described symptom relief in patients with severe cancer pain and anxiety, and anecdotal papers reported positive effects on various symptoms like delirium, dyspnea, vomiting, and depression [8][9][10][27][28][29][30][31]. In terminally ill children, a recent systematic review, based on retrospective evidence, found dexmedetomidine for pain control to be significantly associated with improved quality of life [32].…”

Section: Introductionmentioning

confidence: 99%

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Emergency Palliative Cancer Care: Dexmedetomidine Treatment Experiences—A Retrospective Brief Report on Nine Consecutive Cases

et al. 2023

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Introduction: Dexmedetomidine, an alpha-2 adrenergic receptor agonist with potential opioid sparing properties, is utilized in palliative medicine, but the knowledge base for this practice is limited. We describe concomitant use of dexmedetomidine and opioids in an acute palliative care unit. Methods: We included all hospitalized palliative cancer care patients treated with dexmedetomidine from January 2019 to January 2021. Demographics, opioid doses, dexmedetomidine indications and dosing, reported effects and adverse responses, as well as treatment lengths were recorded. Results: Three women and six men aged 42--66 years with metastatic cancer and Eastern Cooperative Oncology Group (ECOG) performance status I-IV used dexmedetomidine and opioids concomitantly. Indications for dexmedetomidine were pain (n = 7) and anxiety (n = 2). Dexmedetomidine was administered intravenously in two patients and subcutaneously in seven. All administrations were continuous infusions; initial doses ranged from 240 to 1344 lg/24 h with later doses from 240 to 2440 lg/24 h. Physicians reported relief from pain and anxiety, but two patients required neuraxial pain management during admission. At day 2 of dexmedetomidine treatment, the opioid dose was reduced in six out of nine patients. For all patients with available data at day 7, mean opioid dose was reduced to 74% of the initial dose. When excluding the two patients requiring neuraxial pain management, the corresponding number was 80%. Two patients had transient hypotension, but dexmedetomidine was well tolerated and in no cases withdrawn due to adverse effects. Mean

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“…Coyne et al, who looked at the potential role of dexmedetomidine as a bridge to obtaining effective analgesia, proposed a protocol for a low-dose infusion of dexmedetomidine in patients on a palliative care service to be used as, ‘an adjunctive analgesic for refractory pain, may be opioid sparing, and provides a mild sedative effect ( 24 ) ’ . Case reports in the palliative care field report on the ability to provide analgesia, anxiolysis, and ‘conscious sedation’ to allow for control of symptoms while preserving precious time with patients and loved ones ( 25 ).…”

Section: Dexmedetomidine In Palliative Carementioning

confidence: 99%

A new approach to the prevention and treatment of delirium in elderly patients in the intensive care unit

Rosenzweig

Sittambalam

2015

Journal of Community Hospital Internal Medicine Perspectives

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The pronounced prevalence of delirium in geriatric patients admitted to the intensive care unit (ICU) and its increased morbidity and mortality is a well-established phenomenon. The purpose of this review is to explore the potential use of dexmedetomidine in preventing or managing ICU delirium in older patients. Articles used were identified and selected through multiple search engines, including Google Scholar, PubMed, and MEDLINE. Keywords such as dexmedetomidine, delirium, geriatric, ICU delirium, delirium in elderly, and palliative were used to obtain the specific articles used for this paper and restricted to articles published in 1990 or later. Articles specifically looking at the use of dexmedetomidine as compared to a study drug and its potential for use in ICU patients, as opposed to overall reviews of dexmedetomidine, were compared. When compared to benzodiazepines for the prevention or treatment of ICU delirium in the elderly, dexmedetomidine was associated with a reduction in delirium, as well as decreased morbidity and mortality. Dexmedetomidine has also been shown to be effective in limiting risk factors associated with ICU delirium such as length and depth of sedation. As opposed to benzodiazepines or opiates, dexmedetomidine provides effective analgesia, sympatholysis, and anxiolysis without causing respiratory depression and allows a patient to more effectively interact with practitioners. The review of these nine articles indicates that these favorable attributes and overall decreased duration and incidence of delirium make dexmedetomidine a viable option in preventing or reducing ICU delirium in high-risk geriatric patients and as a palliative adjunct to help control symptoms and stressors.

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Dexmedetomidine

Abstract: mechanisms of action, and the safety and efficacy of cannabinoid treatment in this and other chronic pain syndromes. The possibility that cannabinoids may have opioid-sparing effects and may ameliorate opioid withdrawal should also be further investigated.

Cited by 35 publications

References 9 publications

Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study

Dexmedetomidine use for patients in palliative care with intractable pain and delirium: A retrospective study

Emergency Palliative Cancer Care: Dexmedetomidine Treatment Experiences—A Retrospective Brief Report on Nine Consecutive Cases

A new approach to the prevention and treatment of delirium in elderly patients in the intensive care unit

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