Dexmedetomidine withdrawal syndrome and opioid sensitivity

Ferguson, Lana; Hooper, Stacey

doi:10.1136/bmjspcare-2020-002705

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…In a recent case report by Ferguson et al (59), the authors describe the handling of sever neuropathic cancer pain in a 76-year-old woman with urothelial cancer that hat metastasized into the pelvis and lungs. The patient was suffering from a left sacral alar mass, infiltration of the sacrum, perineural invasion of the left sciatic nerve, effacement of the L5/S1, S2 nerve roots, with and infiltration into the lumbosacral plexus.…”

Section: Cancer Painmentioning

confidence: 99%

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Gaertner¹,

Fusi-Schmidhauser²

2022

Ann Palliat Med

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Background and Objective: Dexmedetomidine is a potent adrenergic alpha-2 receptor agonist. It was first approved for sedation for mechanically ventilated patients. Being a sedative medication that is not associated with respiratory depression and holding analgesic properties fosters the interest for this drug in the palliative care field. The primary objectives of this review were to identify the key indications for the real-world use of dexmedetomidine in palliative care and other disciplines.Methods: A narrative review after extensive PubMed search was performed from 1950 to present on October 21st 2021. The language of the publications was restricted to English, German, French and Italian.Key Content and Findings: (I) Current dexmedetomidine use. There is a growing body of evidence that dexmedetomidine may reduce the incidence and severity of delirium, reduce opioid-consumption and postoperative nausea in intensive care settings. It is also used to facilitate withdrawal from different substances (alcohol, opioids, heroin). Concerning safety aspects of the drug, some studies reported an increased rate of serious cardiovascular events in patients with pre-existing heart conditions due to bradycardia and arterial hypo-and hypertension. Since the drug has a main hepatic metabolism, dose reduction is mandatory in patients with hepatic impairment. (II) Dexmedetomidine and palliative care. There have been sporadic case reports about the successful use of dexmedetomidine in palliative care. Indications for symptom control included sedation for hyperactive delirium, cancer pain, opioid-induced-hyperalgesia, dystonia, cough, vomiting, shivering and dyspnea. It is mainly applied via the intravenous (i.v.), subcutaneous, but also nasal and, buccal routes. Admixture ("syringe-driver") studies showed that dexmedetomidine is compatible with morphine, hydromorphone, hyoscine and haloperidol. In 2021, a first prospective cohort study became available. Here, the authors reported promising result for dexmedetomidine use in hyperactive terminal delirium for reducing delirium intensity and agitation. Especially the unique "conscious sedation"or "awake sedation" that allows patients to arouse easily under sedation and report comfort or distress was discussed by the authors. Conclusions:In this review, we present the main findings for dexmedetomidine from palliative care settings and other disciplines. The potential benefits and criticalities of the drug are discussed and practical recommendations for its use are provided.

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Section: Cancer Painmentioning

confidence: 99%

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Gaertner¹,

Fusi-Schmidhauser²

2022

Ann Palliat Med

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“…Dexmedetomidine is known to increase opioid sensitivity. 8,9 This is something we were mindful of given the patient’s background opioid. Neither opioid narcosis or toxicity occurred following initial or subsequent administration of dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Intranasal dexmedetomidine: Procedural sedation in palliative care: A case report

Ferguson

Wilson

2021

Palliat Med

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Background: This report describes the use of intranasal dexmedetomidine to control incident pain and facilitate daily change of dressing in a patient with cutaneous breast cancer. Case presentation: A 45-year-old woman with extensive thoracic cutaneous metastatic bilateral breast cancer requiring daily 2-hour dressing changes to manage significant exudate. Pain during change of dressing was severe and unresponsive to usual analgesics. Deeper sedation was not an option as the patient was required to change position 1 hour into dressing change. Case management: Intranasal dexmedetomidine was administered 40 minutes prior to dressing change and provided effective rousable sedation and analgesia for the duration of the procedure. Case outcome: Dexmedetomidine provided rousable sedation, allowing the patient to follow commands and mobilise during the procedure. Pain was controlled. No adverse cardiovascular effects were noted with the use of intranasal dexmedetomidine. Conclusion: Intranasal dexmedetomidine is a potentially useful medication for procedural sedation in the management of complex wound dressings. It provides rousable short-term sedation, anxiolysis and analgesia. Further research into the role of intranasal dexmedetomidine to facilitate challenging dressing changes in a community setting is warranted.

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Multiple drugs

2024

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Dexmedetomidine withdrawal syndrome and opioid sensitivity

Cited by 6 publications

References 5 publications

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Intranasal dexmedetomidine: Procedural sedation in palliative care: A case report

Multiple drugs

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