Indications of dexmedetomidine in the current sedoanalgesia trends in the critical patient

Ortega, Marcos; Jambrina, C. Chamorro; Vallhonrat, Inés Lipperheide; Simón, I. Fernández

doi:10.1016/j.medine.2013.03.003

Cited by 6 publications

(3 citation statements)

References 47 publications

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“…These conditions pose a risk of NIMV failure. In recent years, the use of dexmedetomidine has become widespread in ICUs for sedation (19). The use of dexmedetomidine during NIMV administration in surgical patientsundergoing major abdominal surgerywith postoperative respiratory failure has not been studied extensively in the literature.…”

Section: Discussionmentioning

confidence: 99%

Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure

Yildirim,

Karaman,

Yıldırım

et al. 2024

Front. Surg.

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ObjectiveThe efficacy of non-invasive mechanical ventilation (NIMV) on the postoperative ARF is conflicting and the failure rate of NIMV in this patient population is high. In our study, we hypothesized that the use of dexmedetomidine during NIMV in major abdominal surgical patients can reduce NIMV failure without significant side affect.MethodsMedical records of patients who underwent major abdominal surgery, admitted to our general surgery intensive care unit (ICU), developed postoperative ARF, received NIMV (with oro-nasal mask) and dexmedetomidine infusion were enrolled in this study. The infusion rate was adjusted to maintain a target sedation level of a Richmond Agitation-Sedation Scale (RASS) (−2)–(−3). The sedation was stopped when NIMV was discontinued.ResultsA total of 60 patients, 42 (70.0%) male, and 18 (30.0%) female, with a mean age of 68 ± 11 years were included in the study. The mean APACHE II score was 20 ± 6. Dexmedetomidine was infused for a median of 25 h (loading dose of 0.2 mcg/kg for 10 min, maintained at 0.2–0.7 mcg/kg/h, titrated every 30 min). RASS score of all study group significantly improved at the 2 h of dexmedetomidine initiation (+3 vs. −2, p = 0.01). A targeted sedation level was achieved in 92.5% of patients. Six (10.0%) patients developed bradycardia and 5 (8.3%) patients had hypotension. The mean NIMV application time was 23.4 ± 6.1 h. Seven (11.6%) patients experienced NIMV failure, all due to worsening pulmonary conditions, and required intubation and invasive ventilation. Fifty-three (88.3%) patients were successfully weaned from NIMV with dexmedetomidine sedation and discharged from ICU. The duration of NIMV application and ICU stay was shorter in NIMV succeded group (21.4 ± 3.2 vs. 29.9 ± 6.4; p = 0.012).ConclusionOur study suggests that dexmedetomidine demonstrates effective sedation in patients with postoperative ARF during NIMV application after abdominal surgery. Dexmedetomidine can be considered safe and capable of improving NIMV success.

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Section: Discussionmentioning

confidence: 99%

Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure

Yildirim,

Karaman,

Yıldırım

et al. 2024

Front. Surg.

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“…This study confirmed the sedative effects of clonidine (drowsiness and tiredness), which are frequently reported by hypertensive patients, and are wellknown side effects of clonidine. 14 Dexmedetomidine has sedative and analgesic properties, inducing a degree of depth of sedation in which patients can respond to verbal stimulation and obey simple commands. 15 Dexmedetomidine does not affect intracranial pressure, but there are some concerns that it might reduce cerebral blood flow leading to ischemia.…”

Section: Cognitive Functionmentioning

confidence: 99%

Clonidine, dexmedetomidine: alpha-2 adrenergic receptor agonists in neuroscience

Eldufani

Elahmer

Nekoui

et al. 2018

Int J Basic Clin Pharmacol

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The alpha-2 adrenergic receptor (α-2 AR) agonists have a long history of use in treating different clinical conditions, such as hypertension, psychiatric entities (e.g., attention-deficit hyperactivity disorder), chronic pain, panic disorders, and, lately, for treating opioid withdrawal syndrome. In recent years, α-2 AR medications have been administered as adjuncts for managing inflammatory conditions, depression, chronic pain, sleep and cognitive disorders. This review will provide some clinical applications in neuroscience for this class of drugs. Understanding the pharmacological mechanisms is essential to obtaining neurochemical data that demonstrate that α-2 AR agonists have potential clinical significance in neuroscience.

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“…Dexmedetomidine is a highly selective α2-adrenergic receptor agonist; its sedation and analgesic effects are similar to opioids [6][7][8][9]. Dexmedetomidine provides a unique "conscious sedation" in which the patient appears to be sleeping and easily aroused, and the sedation and breathing patterns it provides are consistent with natural sleep [10,11]. Dexmedetomidine is an important option for sedation in intensive care [12].…”

Section: Introductionmentioning

confidence: 99%

A comprehensive evaluation between dexmedetomidine and midazolam for intraoperative sedation in the elderly: protocol for a systematic review and meta-analysis of randomized controlled trials

Huang

Long

et al. 2022

Syst Rev

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Background The sedative effect of intraoperative sedation in elderly surgery exerts critical influence on the prognosis. Comparison on the safety and efficacy between dexmedetomidine and midazolam in many clinical randomized controlled trials (RCTs) was inconsistent and suspicious. We aim to comprehensively evaluate the safety and efficacy between dexmedetomidine and midazolam for intraoperative sedation in the elderly via meta-analysis and systematic reviews. Methods RCTs regarding to the comparison of sedative effects and safety between dexmedetomidine and midazolam in elderly patients (aged ≥ 60 years) will be comprehensively searched from 2000 October to 2022 May through 4 English databases and 4 Chinese databases. After extraction in duplicate, the systematic review and meta-analysis will be performed on the primary outcomes (hemodynamic changes, sedative effect, cognitive function) and secondary outcomes (analgesic effect, surgical characteristics, complications, or adverse reactions) for assessing the two therapy methods using Review Manager software (Version 5.3). Sensitivity analysis will be conducted to evaluate the heterogeneity of the results; funnel plot and Egger’s trial will be performed to analyze publication bias of the included studies, and trial sequential analysis will be applied to assess the robustness and reliability of preliminary meta-analysis results. Finally, rating quality of evidence and strength of recommendations on the meta results will be summarized by Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Discussion This systematic review and meta-analysis will evaluate the safety and efficacy between dexmedetomidine and midazolam for intraoperative sedation in the elderly; it will give an insight on the application of dexmedetomidine and midazolam and will provide evidence-based reference for clinical decision-making. Systematic review registration PROSPERO CRD42021221897

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Indications of dexmedetomidine in the current sedoanalgesia trends in the critical patient

Cited by 6 publications

References 47 publications

Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure

Benefits of dexmedetomidine during noninvasive mechanical ventilation in major abdominal surgery patients with postoperative respiratory failure

Clonidine, dexmedetomidine: alpha-2 adrenergic receptor agonists in neuroscience

A comprehensive evaluation between dexmedetomidine and midazolam for intraoperative sedation in the elderly: protocol for a systematic review and meta-analysis of randomized controlled trials

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