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

Abstract

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 Two patients had transient hypotension, but dexmedetomidine was well tolerated and in no cases withdrawn due to adverse effects.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

Efeitos do uso de dexmedetomidina na sedação paliativa de pacientes em fim de vida: revisão sistemática

“…Cada um desses efeitos sugere ainda que pode ser um medicamento útil no cenário de sedação paliativa ou sedação usada durante a retirada do suporte (O'HARA; TAMBURRO; CENEVIVA, 2015). Løhre et al (2023) ressaltam que a dexmedetomidina pode ser associado com drogas como morfina, hidromorfona, haloperidol e hioscina. Segundo Yamout et al (2021) e Hilliard, Brown e Mitchinson (2015) adição de dexmedetomidina a opioides pode atuar como uma terapia ponte para abordagens mais definitivas em pacientes com metástase, pois controlaram com sucesso os níveis de dor sem causar sedação profunda.…”

“…Segundo Yamout et al (2021) e Hilliard, Brown e Mitchinson (2015) adição de dexmedetomidina a opioides pode atuar como uma terapia ponte para abordagens mais definitivas em pacientes com metástase, pois controlaram com sucesso os níveis de dor sem causar sedação profunda. Os mesmos autores afirmam ainda que com a utilização do fármaco controla ou minimiza os efeitos adversos de outros medicamentos e aumenta a analgesia dos opioides (LØHRE et al 2023;YAMOUT et al, 2021).…”

“…As informações de prescrição atuais descrevem limitação na duração de infusão a um período de 24 horas, devido a preocupações sobre tolerância e taquifilaxia, mas nos artigos analisados não foi observado tolerância ou taquifilaxia. Entretanto, em pacientes com insuficiência hepática grave, o uso de dexmedetomidina devem ser cuidadosamente revistos (LØHRE et al, 2023;O'HARA;TAMBURRO;CENEVIVA, 2015).…”

“…Ao contrário dos sedativos paliativos tradicionais como o propofol ou midazolam, a dexmedetomidina oferece a oportunidade para o que tem sido denominado "sedação cooperativa", um estado em que o paciente pode estar acordado ou dormindo levemente (LØHRE et al, 2023;RAHM et al, 2023).…”

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

“…Dexmedetomidine is a selective agonist that binds to presynaptic α 2-adrenoreceptors in the brainstem, creating a negative feedback loop that inhibits the release of norepinephrine and results in rousable anesthesia and sedation [4]. Dexmedetomidine has been shown to reduce pain, anxiety, and delirium without producing respiratory depression and can be given for hours to several days before a patient expires [4][5][6][7][8][9][10]. Dexmedetomidine use has been well established in critical care; however, published evidence for its use in palliative care is limited.…”