Dexmedetomidine in the Treatment of Withdrawal Syndromes in Cardiothoracic Surgery Patients

Abstract

Dexmedetomidine (Precedex, Abbott Laboratories, Abbott Park, IL) is an alpha 2 adrenergic agonist that possesses a high ratio of specificity for the alpha 2 versus the alpha 1 receptor. It is currently approved for the provision of sedation during mechanical ventilation in adults. Given previous experience with clonidine for the treatment of substance withdrawal and the preliminary anecdotal experience with dexmedetomidine, it appears that dexmedetomidine may be a useful agent for treatment of substance withdrawal in the intensive care setting. The authors present their experience with the use of dexmedetomidine to control withdrawal behavior in 3 patients following cardiothoracic surgery. Previous reports regarding the use of dexmedetomidine to treat withdrawal and its potential application in this clinical arena are reviewed.

Central Sympatholysis as a Novel Countermeasure for Cocaine-Induced Sympathetic Activation and Vasoconstriction in Humans

“…Second, because we studied healthy cocaine-naïve subjects, the results cannot be extrapolated to chronic cocaine abusers. However, in isolated case reports dexmedetomidine has been effective in reducing agitation, tachycardia, and hypertension in poly-substance abusers undergoing withdrawal from cocaine, alcohol, and opiates (26,27). Third, here we focused on the human cutaneous circulation and skin sympathetic activity.…”

A rational approach to the treatment of alcohol withdrawal in the ED

“…For example, delirium is a known adverse effect of β-blocker therapy; and one study showed an increase in delirium in AWS when propranolol was used in treatment [104,105]. Two medications in this class have shown some promise, but only as adjuncts: clonidine and dexmedetomidine [64,[106][107][108][109][110][111][112][113][114][115]. However, studies on these 2 medications, especially on the recently popular medication dexmedetomidine, have been small and limited to case reports or small case series; but there may be some promise for use of dexmedetomidine if used as an adjunct to standard therapy with benzodiazepines, phenobarbital, or propofol.…”

Dexmedetomidina: papel atual em anestesia e cuidados intensivos

“…Nevertheless, a few retrospective case reports and series support its potential use 65,66 , ameliorating the hemodynamic effects during withdrawal from illicit drugs and long-term sedation in the ICU. The two largest series are by Tobias 65 (7 patients) and Baddigam et al 66 (3 patients). The infusion dose was in the range 0.25-0.7 µg.kg -1 .h -1 and the duration of treatment was ≤ 3 days.…”