Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

Abstract

Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC), airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 μg kg−1, and infusion dose ranged from 0.2 to 10 μg kg−1 h−1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies.

Dexmedetomidine as an Adjuvant to Levobupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block

“…[3,4,5] Dexmedetomidine is being used for intravenous regional anesthesia (Bier's block), [5,6] intravenous (iv) sedation and analgesia for intubated and mechanically ventilated patients in intensive care units (ICUs). [7,8,9] Its use as an adjuvant in central neuraxial blocks has also been mentioned. [10,11,12,13] Its use in peripheral nerve blocks has recently been described.…”

Study of the Effect of Dexmedetomidine in Reducing Hemodynamic Responses to General Anesthesia for Elective Cesarean Section in Patients with Preeclampsia

“…Depending on the effect of Dexmedetomidine in hemodynamic stability it was started to be used as a sedative prior to and/or during surgical and other procedures in non-intubated adult and pediatric patients in 2008 [3].…”

Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

“…8,9 Dexmedetomidine produces sedation while sparing responsiveness to CO 2 , and thus, it has less effect on respiratory depression. Consequently, it has found utility and regulatory approval for use in bronchoscopic examinations 10 and for weaning intensive care unit patients from mechanical ventilation. 11 In addition, dexmedetomidine has been shown to reduce emergence agitation in children and adults after general anesthesia.…”