The Use of Dexmedetomidine for Longer Than 48 Hours With Evaluation of Its Secondary Outcome in Patients With Liver Disease

Abstract

METHODS: This single center retrospective study included 35 patients over 18 years old who were admitted to our critical care units in the first half of 2015 and received the medication. Patients were divided into two groups; one control group and one group with liver disease as evident by a known diagnosis of liver cirrhosis or abnormal liver function tests indicative of liver disease. RESULTS: Twelve patients had liver disease, with average age of 46.5 years. Average medication duration was 75 hours. The most common indications were delirium in 50% and alcohol withdrawal in 42%. Six patients were extubated, one had a tracheostomy, two were not intubated, and three were terminally weaned. Average length of time from medication discontinuation to extubation was 39.7 hours with average Dexmedetomidine dose of 0.34 mcg/kg/hr. The only side effect was hypotension in one patient. Medication was discontinued in that patient. Twenty-three patients did not have any liver disease, with average age of 47.8 years. Average medication duration was 141 hours. Most common indications were delirium in 83% and alcohol withdrawal in 26%. Thirteen patients were extubated, eight had a tracheostomy, one was terminally weaned, and one was not intubated. Average length of time from medication discontinuation to extubation was 13.5 hours average with Dexmedetomidine dose 0.57 mcg/kg/ hr. Side effects included arrhythmia in two patients (one was life threatening) and hypotension in one patient. Medication was discontinued in all three patients. CONCLUSIONS: Dexmedetomidine was well tolerated in patients with liver disease who received the medication for more than 48 hours. No increase in side effects was noted. This study showed that patients with liver disease required more time before extubation once the medication was discontinued. This can partially be due to the slow metabolism of dexmedetomidine but it can also be affected by slow metabolism of other associated drugs. More controlled randomized studies are needed to test the safety and efficacy in patients with liver disease. CLINICAL IMPLICATIONS: Dexmedetomidine can be used safely in patients with liver disease for more than 48 hours but it can take a longer time for patients to be extubated once the medication is discontinued.

Neuroprotective effects of dexmedetomidine on traumatic brain injury: Involvement of neuronal apoptosis and HSP70 expression

“…Furthermore, it has recently been reported that Dex has the ability to pass freely across the blood brain barrier, and its metabolism predominantly occurs in the liver ( 33 ). In addition, a further recent study demonstrated that patients with liver disease have a significantly decreased clearance rate of Dex ( 36 ). A large proportion of experimental data has suggested that Dex is critically implicated in ischemic/reperfusion models in different organs, including the brain ( 21 ), heart ( 37 ), kidney ( 38 ) and lung ( 39 ).…”