Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Abstract

Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

A Loading Dose of Dexmedetomidine With Constant Infusion Inhibits Intraoperative Neuromonitoring During Thoracic Spinal Decompression Surgery: A Randomized Prospective Study

“…Hence, IONM parameters would be more likely to be inhibited after dexmedetomidine 1 μg kg −1 in 10 min. On the contrary, IONM waveforms would be less likely to be affected when smaller doses of dexmedetomidine were administered (at a constant infusion rate, 0.5 μg kg −1 h −1 ) ( Endrit Bala et al, 2008 ; Chen et al, 2015 ; Li et al, 2016 ; Liu et al, 2021 ).…”

“…Anesthesia induction was consistent with our previous protocol (Tun Liu et al, 2021). Anesthesia was induced by propofol 1.5-2.0 mg kg −1 and sufentanil 0.4-0.6 μg kg −1 , midazolam 0.01 mg kg −1 , and cisatracurium 0.10-0.15 mg kg −1 .…”

“…First, MEP recording has more possibilities of adverse events (Yoshida et al, 1976a). Second, according to the latest guidance (Nuwer et al, 2012a) and our previous study (Tun Liu et al, 2021), it was recommended that every high-risk procedure (Yoshida et al, 1976b) (posterior decompression in OPLL patients and correction in deformity patients) after 10-20 min (Tun Liu et al, 2021), which is a critical time point, needs to put special emphasis on the change of IONM. Therefore, we recorded IONM parameters before and after high-risk procedures or according to specific needs during surgery to judge whether patients have spinal injuries.…”

“…Hence, IONM parameters would be more likely to be inhibited after dexmedetomidine 1 μg kg −1 in 10 min. On the contrary, IONM waveforms would be less likely to be affected when smaller doses of dexmedetomidine were administered (at a constant infusion rate, 0.5 μg kg −1 h −1 ) (Endrit Bala et al, 2008;Chen et al, 2015;Li et al, 2016;Liu et al, 2021). Mahmoud et al (2010) and Mohamed Mahmoud et al ( 2017) reported that dexmedetomidine delivered by loading dose and then a constant infusion rate added to TIVA can decrease MEP amplitude in patients aged between 10 and 25 years.…”

CYP2A6 and GABRA2 Gene Polymorphisms are Associated With Dexmedetomidine Drug Response

“…Dexmedetomidine is a highly selective adrenergic agonist that inhibits noradrenaline release, producing sedation, analgesic, and anxiolytic effects ( Lee, 2019 ). It has been widely used as an adjunct to general anesthesia or for sedation in the intensive care unit (ICU) due to its advantages of intraoperative and postoperative analgesia, sedation without respiratory depression, and low incidence of postoperative nausea and vomiting ( Liu et al, 2021 ).…”