Effects of midazolam and dexmedetomidine on inflammatory responses and gastric intramucosal pH to sepsis, in critically ill patients

Memiş, Dilek; Hekimoglu, Sevtap; Vatan, I.; Yandım, T.; Yüksel, Mahmut; Süt, Necdet

doi:10.1093/bja/aem017

Cited by 113 publications

(105 citation statements)

References 8 publications

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“…39 We speculated that producing a state akin to natural sleep with dexmedetomidine would be a better strategy than delirium-enhancing sedativehypnotics, such as benzodiazepines, that produce an immobilised state that is unlike natural sleep. 40 Apart from the dexmedetomidine-induced improvements in hypoxaemia, analgesia, and sleep in this study, a possible mechanism for dexmedetomidine's postoperative deliriumreducing property might also be attributed to its actions on infl ammation that are evident both clinically 41 and in preclinical models. 42 A strong association has been shown between elevated biomarkers of infl ammation and the risk for developing delirium; 43 the causal nature of this relationship has been repeatedly shown in preclinical studies.…”

Section: Discussionmentioning

confidence: 78%

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

et al. 2016

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Section: Discussionmentioning

confidence: 78%

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

et al. 2016

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“…An important objective in the management of these patients is to achieve an adequate level of sedation and analgesia. Previous findings indicate that DEX prevents inflammatory effects in septic patients during sedation (63).…”

Section: Inflammatory Responsementioning

confidence: 94%

Molecular targets and mechanism of action of dexmedetomidine in treatment of ischemia/reperfusion injury (Review)

Cai

Jia

et al. 2014

Molecular Medicine Reports

110

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Abstract. Dexmedetomidine (DEX), a highly specific α 2 -adrenergic agonist, which exhibits anaesthetic-sparing, analgesia and sympatholytic properties. DEX modulates gene expression, channel activation, transmitter release, inflammatory processes and apoptotic and necrotic cell death. It has also been demonstrated to have protective effects in a variety of animal models of ischemia/reperfusion (I/R) injury, including the intestine, myocardial, renal, lung, cerebral and liver. The broad spectrum of biological activities associated with DEX continues to expand, and its diverse effects suggest that it may offer a novel therapeutic approach for the treatment of human diseases with I/R involvement.

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“…Due to the additional data presented by these studies, higher doses and longer durations of therapy compared to those FDA-approved for dexmedetomidine are now used in practice. Data evaluating doses greater than 1.5 mcg/kg/hr is limited; however, doses up to 2.5 mcg/kg/hr have been utilized [11][12][13][14]. It is uncertain whether higher doses provide any additional benefit but may result in more adverse events.…”

Section: Journal Of Intensive and Critical Care Issn 2471-8505mentioning

confidence: 99%

A Retrospective Review of High versus Standard Dose Dexmedetomidine for Sedation in Critically Ill Patients

Rodriguez¹,

Anderson²,

Keriazes³

et al. 2016

Intensive & Crit Care

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Introduction: Studies have demonstrated safety and efficacy of dexmedetomidine infusions at doses up to 1.5 mcg/kg/hr. Data evaluating doses greater than 1.5 mcg/kg/hr is limited; however, up to 2.5 mcg/kg/hr has been utilized. It is uncertain whether higher doses provide additional benefit but may result in more adverse events. The purpose of this study was to compare the safety and efficacy of dexmedetomidine at high doses (greater than 1.5 mcg/kg/hr) versus standard doses (0.2 to 1.5 mcg/kg/hr). Methods:A retrospective cohort study was conducted in critically ill, mechanically ventilated patients receiving dexmedetomidine for at least 24 hours. Standard dose dexmedetomidine (SD-DEX) was defined as less than or equal to 1.5 mcg/kg/ hr and high dose (HD-DEX) as greater than 1.5 mcg/kg/hr. Patients were assigned to SD-DEX group if maximum dose of dexmedetomidine received was between 0.2 and 1.5 mcg/kg/hr. Conversely, patients were assigned to HD-DEX group if maximum dose of dexmedetomidine received was greater than 1.5 mcg/kg/hr. Composite incidence of bradycardia or hypotension and proportion of time within target sedation were assessed.Results: A total of 799 patients were screened for inclusion with 120 included: 69 in the HD-DEX group and 51 in the SD-DEX group. Composite incidence of bradycardia or hypotension was not statistically different. A significantly larger proportion of time was spent within target sedation in the SD-DEX group. More patients in the HD-DEX group required sedatives and antipsychotics than the SD-DEX group and tended to receive higher daily doses of concomitant medications. Conclusion:Dexmedetomidine doses greater than 1.5 mcg/kg/hr may be as safe as standard doses; however, no additional benefit in maintaining target sedation level was found.

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Effects of midazolam and dexmedetomidine on inflammatory responses and gastric intramucosal pH to sepsis, in critically ill patients

Cited by 113 publications

References 8 publications

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

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

Molecular targets and mechanism of action of dexmedetomidine in treatment of ischemia/reperfusion injury (Review)

A Retrospective Review of High versus Standard Dose Dexmedetomidine for Sedation in Critically Ill Patients

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