Evaluation of long-term infusion of dexmedetomidine in critically ill patients: A retrospective analysis

Abuhasna, Said; Jundi, Amer Al; Abdelatty, Wael; Ur-Rahman, Masood

doi:10.4103/2229-5151.97270

Cited by 10 publications

(4 citation statements)

References 15 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Many adult studies have demonstrated the safety of dexmedetomidine use longer than 24 hours (26)(27)(28)(29), and limited pediatric studies show a similar safety profile of long-term dexmedetomidine to that of adults (8,10,12,20,22). Our study mirrors the findings of both the adult and the pediatric data.…”

Section: Discussionsupporting

confidence: 91%

Long-Term Dexmedetomidine Use and Safety Profile Among Critically Ill Children and Neonates*

Whalen

Gennaro

Irby

et al. 2014

Pediatric Critical Care Medicine

104

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 91%

Long-Term Dexmedetomidine Use and Safety Profile Among Critically Ill Children and Neonates*

Whalen

Gennaro

Irby

et al. 2014

Pediatric Critical Care Medicine

104

View full text Add to dashboard Cite

show abstract

“…It is our practice to use dexmedetomidine as the primary sedative agent because it exhibits neurocognitive protective effects and is associated with a decreased incidence of delirium compared to other commonly used sedatives 34–36 . Its excellent safety record—less respiratory depression and superior sympatholysis compared to other sedatives—is another advantage of its use in the elderly 35,37–41 . Dexmedetomidine produces a “cooperative sedation” that mimics natural sleep; thus, patients are easily arousable and are less prone to startling from waxing and waning states of consciousness, a phenomenon often observed with the use of propofol 38,40,42 …”

Section: Discussionmentioning

confidence: 99%

Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Cases

et al. 2020

View full text Add to dashboard Cite

Objective To report the outcomes on a large series of elderly patients who underwent cochlear implantation (CI) surgery under local anesthesia with conscious sedation (LA‐CS). Methods Retrospective chart review on 100 consecutive elderly patients (> 65 years) who underwent CI with LA‐CS at a tertiary care center between August 2013 and January 2020. An age‐matched control group of 50 patients who underwent CI with general anesthesia (GA) are used for comparison. Outcomes measured included time in the operating room, time in the postanesthesia care unit (PACU), and rate of adverse events. Results Cochlear implant surgery under LA‐CS was successfully performed in 99 (99%) patients. One patient requiring conversion to GA intraoperatively. No patients in the LA‐CS group experienced cardiopulmonary adverse events; however, three patients (6%) in the GA group experienced minor events including atrial fibrillation and/or demand ischemia. Overnight observation in the hospital due to postoperative medical concerns or prolonged wake‐up from anesthesia was required in one patient (1%) from the LA‐CS cohort and 12 patients (24%) from the GA cohort. Perioperative adverse events exclusive to the LA‐CS group included severe intraoperative vertigo (8%), temporary facial nerve paresis (3%), and wound infection (1%). The average amount of time spent in the operating room was 37 minutes less for procedures performed under LA‐CS compared to GA (P < .05). The average amount of time in recovery was similar for both groups (P > .05). Conclusion Cochlear implant surgery under LA‐CS offers many benefits and is a safe, feasible, and cost‐effective alternative to GA when performed by experienced CI surgeons. Level of Evidence 3 Laryngoscope, 131:E946–E951, 2021

show abstract

“…Due to a lack of central depression, dexmedetomidine is an attractive sedative clinically for weaning from mechanical ventilation and awake sedation in non-intubated patients. Dexmedetomidine was licensed by the Food and Drug Administration as a sedative with a 24-h time limit; however, studies have shown that it is safe and effective for up to 5 d with bradycardia and hypotension being the most commonly reported adverse effects[ 4 , 9 - 11 ]. Other drawbacks have included the cost of drug acquisition and availability only in an IV formulation[ 12 - 14 ].…”

Section: Introductionmentioning

confidence: 99%

Clonidine use during dexmedetomidine weaning: A systematic review

Rajendraprasad¹,

Wheeler²,

Wieruszewski³

et al. 2023

World J Crit Care Med

View full text Add to dashboard Cite

BACKGROUND Dexmedetomidine is a centrally acting alpha-2A adrenergic agonist that is commonly used as a sedative and anxiolytic in the intensive care unit (ICU), with prolonged use increasing risk of withdrawal symptoms upon sudden discontinuation. As clonidine is an enterally available alpha-2A adrenergic agonist, it may be a suitable agent to taper off dexmedetomidine and reduce withdrawal syndromes. The appropriate dosing and conversion strategies for using enteral clonidine in this context are not known. The objective of this systematic review is to summarize the evidence of enteral clonidine application during dexmedetomidine weaning for prevention of withdrawal symptoms. AIM To systematically review the practice, dosing schema, and outcomes of enteral clonidine use during dexmedetomidine weaning in critically ill adults. METHODS This was a systematic review of enteral clonidine used during dexmedetomidine weaning in critically ill adults (≥ 18 years). Randomized controlled trials, prospective cohorts, and retrospective cohorts evaluating the use of clonidine to wean patients from dexmedetomidine in the critically ill were included. The primary outcomes of interest were dosing and titration schema of enteral clonidine and dexmedetomidine and risk factors for dexmedetomidine withdrawal. Other secondary outcomes included prevalence of adverse events associated with enteral clonidine use, re-initiation of dexmedetomidine, duration of mechanical ventilation, and ICU length of stay. RESULTS A total of 3427 studies were screened for inclusion with three meeting inclusion criteria with a total of 88 patients. All three studies were observational, two being prospective and one retrospective. In all included studies, the choice to start enteral clonidine to wean off dexmedetomidine was made at the discretion of the physician. Weaning time ranged from 13 to 167 h on average. Enteral clonidine was started in the prospective studies in a similar protocolized method, with 0.3 mg every 6 h. After starting clonidine, patients remained on dexmedetomidine for a median of 1-28 h. Following the termination of dexmedetomidine, two trials tapered enteral clonidine by increasing the interval every 24 h from 6 h to 8h, 12h, and 24 h, followed by clonidine discontinuation. For indicators of enteral clonidine withdrawal, the previously tolerable dosage was reinstated for several days before resuming the taper on the same protocol. The adverse events associated with enteral clonidine use were higher than patients on dexmedetomidine taper alone with increased agitation. The re-initiation of dexmedetomidine was not documented in any study. Only 17 (37%) patients were mechanically ventilated with median duration of 3.5 d for 13 patients in one of the 2 studies. ICU lengths of stay were similar. CONCLUSION Enteral clonidine is a strategy to wean critically ill patients from dexmedetomidine. There is an asso...

show abstract

Evaluation of long-term infusion of dexmedetomidine in critically ill patients: A retrospective analysis

Cited by 10 publications

References 15 publications

Long-Term Dexmedetomidine Use and Safety Profile Among Critically Ill Children and Neonates*

Long-Term Dexmedetomidine Use and Safety Profile Among Critically Ill Children and Neonates*

Cochlear Implantation Under Local Anesthesia With Conscious Sedation in the Elderly: First 100 Cases

Clonidine use during dexmedetomidine weaning: A systematic review

Contact Info

Product

Resources

About