The Role of the α₂-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit

Abstract

Dexmedetomidine was evaluated for sedation of 401 post-surgical patients in this double-blind, randomized, placebo-controlled, multicenter trial. Dexmedetomidine or saline was started on arrival in the intensive care unit (ICU) (1.0 mcg/kg for 10 minutes), then titrated at 0.2 to 0.7 mcg/kg/h to effect. Patients could be given propofol if necessary. Morphine was administered for pain. Sixty percent of the dexmedetomidine patients required no other sedative to maintain an RSS > or = 3; 21% required < 50 mg propofol. In contrast, 76% of the control group received propofol; 59% required > or = 50 mg. Dexmedetomidine patients required significantly less morphine for pain relief (P <.001). Continuously given throughout the ICU stay, dexmedetomidine had no effect on respiratory rate, oxygen saturation, duration of weaning, or times to extubation. Nurses judged the dexmedetomidine patients were easier to manage. Later, fewer dexmedetomidine patients remembered pain or discomfort. The majority of dexmedetomidine patients maintained blood pressures within normal range, without rebound. Hypertension, atelectasis, and rigors occurred more frequently in the control group, while hypotension and bradycardia occurred more frequently in the dexmedetomidine group. Preoperative cardiovascular conditions were not risk factors for dexmedetomidine patients.

Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

“…Confusion, cited as a common problem for other traditional sedatives, has not been described for DEX as it does not depend primarily on activation of the g aminobutyric acid system. 23 Although rapid recovery without residual sedation is a major objective in out-patient adult surgery, a certain degree of sedation after pediatric surgery might represent a desired effect by the parents. A calm and sedated child during the early post-operative period could decrease the parent's anxiety.…”

Effect of Adding Dexmedetomidine versus Fentanyl to Intrathecal Bupivacaine on Spinal Block Characteristics in Gynecological Procedures: A Double Blind Controlled Study

“…DXM is a highly selective 2-adrenoreceptor agonist approved as intravenous sedative and adjuvant to anesthesia. DXM when used intravenously during anesthesia reduces opioid and inhalational anesthetics requirements [21,22] . Compared with clonidine a 2-adrenoreceptor agonist, the affinity of DXM to 2 receptors has been reported to be 10 times more than clonidine [23] , moreover, Kalso et al [5] and Post et al [24] reported a 1:10 dose ratio between intrathecal DXM and clonidine in animals.…”

A Comparison of Dexmedetomidine and Midazolam for Sedation in Gynecologic Surgery Under Epidural Anesthesia

“…Its affinity for binding to the alpha-2/alpha-1 receptor is 1300:1 compared with 39:1 for clonidine [3,4]. It has potent sedative analgesia-sparing properties [5 -11].…”