Journal: Curr Opin Anaesthesiol 21(4):457-461, 2008. 31 References
Reprint: Department of Anesthesiology, Ochsner Clinic Foundation, 1514 Jefferson Hwy, New Orleans, LA 71121 (U Ramadhyani, MD)
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
Dexmedetomidine is a highly selective α2 adrenoreceptor agonist that has been shown to have both sedative and analgesic effects. Compared with clonidine, which is an alpha2 agonist that has been used for the treatment of hypertension, dexmedetomidine has an α2:α1 adrenoreceptor ratio of approximately 1600:1, seven to eight times higher than clonidine. This makes it primarily a sedative-anxiolytic. The elimination half-life of dexmedetomidine is 2 hours vs. 8 hours for clonidine. The short half-life of dexmedetomidine is 6 minutes, making it an ideal drug for intravenous titration.
Dexmedetomidine is a useful medication with many clinical applications. For ICU, effective sedation in mechanically ventilated patients for a prolonged period can be difficult to maintain. The Food and Drug Administration approved dexmedetomidine for sedation in initially intubated patients for a period of 24 hours. The anesthetic plan in many neurosurgical procedures is usually to have a deep plane of anesthesia during the highly stimulating craniotomy and then awaken the patient in order to allow for neurocognitive testing. Dexmedetomidine is a valuable aid in this situation. Pediatric procedural sedation is better achieved with dexmedetomidine over midazolam for less movement and sedation. Dexmedetomidine can significantly attenuate postoperative pain and reduce opioid requirements, while not appearing to cause respiratory depression in morbidly obese patients undergoing bariatric surgery.
Dexmedetomidine is a useful medication with applications in many clinical situations. The medication has shown efficacy in decreasing the need for opioids, benzodiazepines, and propofol. Short term sedation has been shown to be safe in studies although hypotension and bradycardia are the most significant side effects. Dexmedetomidine is emerging as an effective therapeutic agent in support of the management of a wide range of clinical conditions with an efficacious, safe profile. |
