Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting

Keating, Gillian M.

doi:10.1007/s40265-015-0419-5

Cited by 290 publications

(248 citation statements)

References 61 publications

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“…[91][92][93] Dexmedetomidine Dexmedetomidine is a selective α 2 -agonist primarily used for sedation. 94,95 Despite its ability to decrease acute postoperative pain and improve long-term outcomes including a decreased incidence of postoperative complications including major adverse cardiac events, delirium, and overall mortality up to 1 year postoperatively, no evidence exists to support a decrease in chronic pain. 96,97 Glucocorticoids Glucocorticoids have an extensive history of use in cardiac surgery but the Steroids In Cardiac Surgery trial showed no difference in pain at 30 days or in chronic incisional pain at 6 months.…”

Section: Remifentanilmentioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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Section: Remifentanilmentioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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“…It is necessary to mention that the use of DEX beyond 24 hours may be associated with a dose-related increase in adverse events and for this reason, the Food and Drug Administration (FDA) has not recommended the use of DEX for more than 24 hours [27,28] . However, the safe use of this drug has been reported from 24 hours to more than a week [28,29] .…”

Section: Discussionmentioning

confidence: 99%

“…Most of these side effects occur at infusion of 0.2-0.7 mcg/kg/h without a bolus dose [28,31] . In our review, the occurrence of respiratory depression was low and reported only in one trials [14] , which is consistent with previous studies [11,28,31] . Previous study showed that respiratory suppression does not even occur at DEX plasma levels up to 8.0 ng/mL and only there is a risk of over-sedation [32] .…”

Section: Discussionmentioning

confidence: 99%

“…DEX, a shorter-acting and highly selective presynaptic alpha-2-receptor agonist, also possesses pharmacologic sedative, hypnotic, anti-anxious, sympatholytic and analgesic properties [28] . Its analgesic and opioid-sparing effects are dose-dependent and trigger at spinal cord sites as well as through non-spinal mechanisms [29] .…”

Section: Discussionmentioning

confidence: 99%

“…As a method of limiting opioid-induced adverse events, therefore, multimodal POP management has the potential to decrease morbidity and mortality after surgery [35] . Consequently, it is expected that the sedative, anesthetic, analgesic, and cardiorespiratory effects of DEX may enhance with concomitant administration with other anesthetic, sedative and analgesic medications [28] . In our review, regardless of the route of administration, three studies used the multimodal approaches and found a reduction in the narcotic consumption and supplemental analgesics requirements [14,17,19] .…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Hassani¹,

Kiabi²,

Sharifi³

2018

Braz J Cardiovasc Surg

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IntroductionAcute post-operative pain remains a troublesome complication of cardiothoracic surgeries. Several randomized controlled trials have examined the efficacy of dexmedetomidine as a single or as an adjuvant agent before, during and after surgery. However, no evidence-based conclusion has been reached regarding the advantages of dexmedetomidine over the other analgesics.ObjectiveTo review the effect of dexmedetomidine on acute post-thoracotomy/sternotomy pain.MethodsMedline, SCOPUS, Web of Science, and Cochrane databases were used to search for randomized controlled trials that investigated the analgesia effect of dexmedetomidine on post-thoracotomy/sternotomy pain in adults' patients. The outcomes were postoperative pain intensity or incidence, postoperative analgesia duration, and the number of postoperative analgesic requirements.ResultsFrom 1789 citations, 12 trials including 804 subjects met the inclusion criteria. Most studies showed that pain score was significantly lower in the dexmedetomidine group up to 24 hours after surgery. Two studies reported the significant lower postoperative analgesia requirements and one study reported the significant lower incidence of acute pain after surgery in dexmedetomidine group. Ten studies found that the total consumption of narcotics was significantly lower in the dexmedetomidine group. The most reported complications of dexmedetomidine were nausea/vomiting, bradycardia and hypotension.ConclusionDexmedetomidine can be used as a safe and efficient analgesic agent for reducing the postoperative pain and analgesic requirements up to 24 hours after cardiothoracic surgeries. However, further well-designed trials are needed to find the optimal dosage, route, time, and duration of dexmedetomidine administration.

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Sublingual Dexmedetomidine as a Potential New Treatment for Agitation

Hsiao

2022

JAMA

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cal setting is a crisis demanding swift and safe resolution. Traditionally, behavioral agitation, often due to psychosis, was managed by psychiatry, particularly when physical restraints were the primary options. 1 After chlorpromazine's calming, neuroleptic properties were recognized in the 1950s, 2 pharmacological management became possible. Additional first-generation neuroleptic antipsychotics were introduced through the 1960s. In subsequent decades, the pharmaceutical industry developed the second-generation antipsychotics and benzodiazepines now used to treat agitation.Today, emergency departments now rival and perhaps surpass psychiatric units as settings where out-of-control, agitated patients must be managed. Both settings share basic approaches: ensuring patient and staff safety, deescalation as the preferred intervention, and avoidance of physical restraint. Intramuscular antipsychotic agents (olanzapine, ziprasidone, haloperidol) and benzodiazepines (midazolam, lorazepam) are the initial choice for chemical management. 3 However, psychiatrists and emergency physicians diverge somewhat in their ultimate objective managing agitation.In the emergency department, the target outcome is control of aggression and rapid sedation. If antipsychotics (such as haloperidol) and benzodiazepines are insufficient, some emergency medicine clinicians may use parenteral ketamine, a dissociative anesthetic. In a study of acute agitation in an emergency department, 66% (27 of 41) of patients who received ketamine were sedated within 15 minutes, compared with 7% (3 of 45) of patients who received haloperidol and lorazepam. 4 In contrast, in psychiatry, consensus recommendations for managing agitation emphasize that "the 'ideal' medication should calm without over-sedate." 5 A sleeping patient is difficult to engage, but psychiatry's aversion to excessive sedation may also reflect a salutary reaction to its earlier enthusiasm for rapid tranquilization with megadose, parenteral antipsychotics; an approach that is now thoroughly discredited. 6 Critical care is another setting where agitation is common and must be quickly controlled. Untreated agitated delirium could be catastrophic for a critically ill patient in the intensive care unit (ICU) connected to multiple monitors, intravenous (IV) and intra-arterial lines, and receiving mechanical ventilation. Parenteral haloperidol had been the choice for managing agitated delirium of adults in the ICU. 7 However, guidelines from 2018 recommend that dexmedetomidine be used to manage agitated delirium rather than haloperidol or other antipsychotics and recommend dexmedetomidine or propofol rather than benzodiazepines for sedation for adults receiving mechanical ventilation. 7

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Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting

Cited by 290 publications

References 61 publications

Chronic Poststernotomy Pain

Chronic Poststernotomy Pain

The Effect of Dexmedetomidine on the Acute Pain After Cardiothoracic Surgeries: A Systematic Review

Sublingual Dexmedetomidine as a Potential New Treatment for Agitation

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