Dexmedetomidine for sedation in intensive care. Literature review and clinical experience

Authors

  • Dmytro Dmytriiev Vinnytsia Regional Clinical Highly Specialized Endocrinology Center
  • Dmytro Bortnik Vinnytsia Regional Clinical Highly Specialized Endocrinology Center
  • Y Rudnitsky Vinnytsia Regional Clinical Highly Specialized Endocrinology Center
  • S Heranin Vinnytsia Regional Clinical Highly Specialized Endocrinology Center
  • N Korenchuk Vinnytsia Regional Clinical Highly Specialized Endocrinology Center

DOI:

https://doi.org/10.31636/prmd.v3i1.6

Keywords:

dexmedetomidine, sedation, pain, intensive care, sleep, delirium

Abstract

Dexmedetomidine is a fairly new and promising drug for use in intensive care and surgery. Due to the fact that it is an agonist of alpha-2-adrenoceptors, dexmedetomidine has an analgesic, sedative effect and affects hemodynamic parameters. Due to the fact that dexmedetomedin does not have the ability to suppress respiration, it is used in patients with respiratory disorders. Dexmedetomidine has minimal side effects and a wide range of uses.

Downloads

Download data is not yet available.

References

Maze M, Angst MS. Dexmedetomidine and Opioid Interactions: Defining the Role of Dexmedetomidine for Intensive Care Unit Sedation. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Nov;101(5):1059–61. Available from: http://dx.doi.org/10.1097/00000542-200411000-00002 DOI: https://doi.org/10.1097/00000542-200411000-00002

Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The α2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Feb;98(2):428–36. Available from: http://doi.org/10.1097/00000542-200302000-00024 DOI: https://doi.org/10.1097/00000542-200302000-00024

Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia [Internet]. Wiley; 1999 Dec;54(12):1136–42. Available from: http://doi.org/10.1046/j.1365-2044.1999.01114.x DOI: https://doi.org/10.1046/j.1365-2044.1999.01114.x

Angst MS, Ramaswamy B, Davies MF, Maze M. Comparative Analgesic and Mental Effects of Increasing Plasma Concentrations of Dexmedetomidine and Alfentanil in Humans. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Sep;101(3):744–52. Available from: http://doi.org/10.1097/00000542-200409000-00024 DOI: https://doi.org/10.1097/00000542-200409000-00024

Cortinez LI, Hsu Y-W, Sum-Ping ST, Young C, Keifer JC, MacLeod D, et al. Dexmedetomidine Pharmacodynamics: Part II. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Nov;101(5):1077–83. Available from: http://doi.org/10.1097/00000542-200411000-00006 DOI: https://doi.org/10.1097/00000542-200411000-00006

Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The Effects of Increasing Plasma Concentrations of Dexmedetomidine in Humans. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2000 Aug;93(2):382–94. Available from: http://doi.org/10.1097/00000542-200008000-00016

Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Jan;153–8. Available from: http://doi.org/10.1213/01.ane.0000093225.39866.75

Aryan HE, Box KW, Ibrahim D, Desiraju U, Ames CP. Safety and efficacy of dexmedetomidine in neurosurgical patients. Brain Injury [Internet]. Informa UK Limited; 2006 Jan;20(8):791–8. Available from: http://doi.org/10.1080/02699050600789447 DOI: https://doi.org/10.1080/02699050600789447

Zornow MH, Scheller MS, Sheehan PB et al. Intracranial pressure effects ofdexmedetomidine in rabbits. Anesth. Analg. 1992;75:232—237.

Farag E, Argalious M, Sessler DI, et al. Use of alpha(2)-agonists in neuroanesthesia: An overview. Ochsner J. 2011;11(1):57—69.

Huupponen E, Maksimow A, Lapinlampi P, Särkelä M, Saastamoinen A, Snapir A, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiologica Scandinavica [Internet]. Wiley; 2008 Feb;52(2):289–94. Available from: http://doi.org/10.1111/j.1399-6576.2007.01537.x

Paris A, Tonner PH Dexmedetomidine in anaesthesia. Curr. Opin. Anaesthesiol 2 005;18:412—418. DOI: https://doi.org/10.1097/01.aco.0000174958.05383.d5

Engelhard K, Werner C, Eberspächer E, Bachl M, Blobner M, Hildt E, et al. The Effect of the α2-Agonist Dexmedetomidine and the N-Methyl-d-Aspartate Antagonist S(+)-Ketamine on the Expression of Apoptosis-Regulating Proteins After Incomplete Cerebral Ischemia and Reperfusion in Rats. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Feb;96(2):524–31. Available from: http://doi.org/10.1213/00000539-200302000-00041 DOI: https://doi.org/10.1213/00000539-200302000-00041

Frölich MA, Arabshahi A, Katholi C, Prasain J, Barnes S. Hemodynamic characteristics of midazolam, propofol, and dexmedetomidine in healthy volunteers. Journal of Clinical Anesthesia [Internet]. Elsevier BV; 2011 May;23(3):218–23. Available from: http://doi.org/10.1016/j.jclinane.2010.09.006 DOI: https://doi.org/10.1016/j.jclinane.2010.09.006

Bloor BC, Ward DS, Belleville JP, Maze M. Effects of Intravenous Dexmedetomidine in Humans. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1992 Dec;77(6):1134–42. Available from: http://doi.org/10.1097/00000542-199212000-00014 DOI: https://doi.org/10.1097/00000542-199212000-00014

Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidineinhumans. Anesthesiology 2000;93:382—394. DOI: https://doi.org/10.1097/00000542-200008000-00016

E. Ramsay MA, Luterman DL. Dexmedetomidine as a Total Intravenous Anesthetic Agent. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Sep;101(3):787–90. Available from: http://doi.org/10.1097/00000542-200409000-00028 DOI: https://doi.org/10.1097/00000542-200409000-00028

Scholz J, Tonner PH Alpha2-adrenoceptor agonists in anaesthesia: a new paradigm. Curr. Opin. Anaesthesiol. 2000;13:437—442.

Precedex (dexmedetomidine hydrochloride) injection. For intravenous use. — Prescribing information. LakeForest, IL, USA: HospiraInc. 2011.

Farag E, Argalious M, Sessler DI, et al. Use of alpha(2)-agonists in neuroanesthesia: An overview. Ochsner J. 2011; 11 (1): 57—69.

Jakob SM. Dexmedetomidine vs Midazolam or Propofol for Sedation During Prolonged Mechanical Ventilation. JAMA [Internet]. American Medical Association (AMA); 2012 Mar 21;307(11):1151. Available from: http://doi.org/10.1001/jama.2012.304 DOI: https://doi.org/10.1001/jama.2012.304

Klamt JG, de Andrade Vicente WV et al. Effects of dexmedetomidine-fentanyl infusion on blood pressure and heart rate during cardiac surgery in children. Anаesthesiol. Res. Pract. 2010. DOI: https://doi.org/10.1155/2010/869049

Wijeysundera DN, Naik JS, Scott Beattie W. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: The American Journal of Medicine [Internet]. Elsevier BV; 2003 Jun;114(9):742–52. Available from: http://doi.org/10.1016/s0002-9343(03)00165-7 DOI: https://doi.org/10.1016/S0002-9343(03)00165-7

Jaionen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, et al. Dexmedetomidine as an Anesthetic Adjunct in Coronary Artery Bypass Grafting. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1997 Feb;86(2):331–45. Available from: http://doi.org/10.1097/00000542-199702000-00009 DOI: https://doi.org/10.1097/00000542-199702000-00009

Hofer RE, Sprung J, Sarr MG, Wedel DJ. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Canadian Journal of Anesthesia/Journal canadien d’anesthésie [Internet]. Springer Science and Business Media LLC; 2005 Feb;52(2):176–80. Available from: http://doi.org/10.1007/bf03027725 DOI: https://doi.org/10.1007/BF03027725

Abdelmalak B, Makary L, Hoban J, Doyle DJ. Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. Journal of Clinical Anesthesia [Internet]. Elsevier BV; 2007 Aug;19(5):370–3. Available from: http://doi.org/10.1016/j.jclinane.2006.09.006 DOI: https://doi.org/10.1016/j.jclinane.2006.09.006

Koroglu A, Demirbilek S, Teksan H, Sagır O, But AK, Ersoy MO. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. British Journal of Anaesthesia [Internet]. Elsevier BV; 2005 Jun;94(6):821–4. Available from: http://doi.org/10.1093/bja/aei119 DOI: https://doi.org/10.1093/bja/aei119

Meng Q, Xia Z, Luo T, Wu Y, Tang L, Zhao B, et al. Dexmedetomidine reduces emergence agitation after tonsillectomy in children by sevoflurane anesthesia: A case-control study. International Journal of Pediatric Otorhinolaryngology [Internet]. Elsevier BV; 2012 Jul;76(7):1036–41. Available from: http://doi.org/10.1016/j.ijporl.2012.03.028 DOI: https://doi.org/10.1016/j.ijporl.2012.03.028

Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. European Journal of Cardio-Thoracic Surgery [Internet]. Oxford University Press (OUP); 2017 Mar 27;52(4):665–72. Available from: http://doi.org/10.1093/ejcts/ezx039 DOI: https://doi.org/10.1093/ejcts/ezx039

Almassi GH, Schowalter T, Nicolosi AC, Aggarwal A, Moritz TE, Henderson WG, et al. Atrial Fibrillation After Cardiac Surgery. Annals of Surgery [Internet]. Ovid Technologies (Wolters Kluwer Health); 1997 Oct;226(4):501–13. Available from: http://doi.org/10.1097/00000658-199710000-00011 DOI: https://doi.org/10.1097/00000658-199710000-00011

Liu X, Zhang K, Wang W, Xie G, Fang X. Dexmedetomidine sedation reduces atrial fibrillation after cardiac surgery compared to propofol: a randomized controlled trial. Critical Care [Internet]. Springer Science and Business Media LLC; 2016 Sep 21;20(1). Available from: http://doi.org/10.1186/s13054-016-1480-5 DOI: https://doi.org/10.1186/s13054-016-1480-5

Turan A, Bashour CA, You J, Kirkova Y, Kurz A, Sessler DI, et al. Dexmedetomidine sedation after cardiac surgery decreases atrial arrhythmias. Journal of Clinical Anesthesia [Internet]. Elsevier BV; 2014 Dec;26(8):634–42. Available from: http://doi.org/10.1016/j.jclinane.2014.05.009 DOI: https://doi.org/10.1016/j.jclinane.2014.05.009

Yang Liu1, Lei Zhang2, Suozhu Wang1, Feiping Lu1, Jie Zhen1, Wei Chen. Dexmedetomidine Reduces Atrial Fibrillation After Adult Cardiac Surgery: A Meta Analysis of Randomized Controlled Trials.

Mantz J, Josserand J, Hamada S. Dexmedetomidine: new insights. Eur J Anaesthesiol 2011;28:3-6. DOI: https://doi.org/10.1097/EJA.0b013e32833e266d

Yoshitomi T, Kohjitani A, Maeda S, Higuchi H, Shimada M, Miyawaki T. Dexmedetomidine Enhances the Local Anesthetic Action of Lidocaine via an α-2A Adrenoceptor. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Jul;107(1):96–101. Available from: http://doi.org/10.1213/ane.0b013e318176be73 DOI: https://doi.org/10.1213/ane.0b013e318176be73

Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The Efficacy of Dexmedetomidine Versus Morphine for Postoperative Analgesia After Major Inpatient Surgery. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2004 Jan;153–8. Available from: http://doi.org/10.1213/01.ane.0000093225.39866.75 DOI: https://doi.org/10.1213/01.ANE.0000093225.39866.75

Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice-a review. Journal of clinical and diagnostic research: JCDR. 2014 Oct;8(10):GE01-GE04. DOI: https://doi.org/10.7860/JCDR/2014/9624.4946

Obayah GM, Refaie A, Aboushanab O, Ibraheem N, Abdelazees M. Addition of dexmedetomidine to bupivacaine for greater palatine nerve block prolongs postoperative analgesia after cleft palate repair. European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2010 Mar;27(3):280–4. Available from: http://doi.org/10.1097/eja.0b013e3283347c15 DOI: https://doi.org/10.1097/EJA.0b013e3283347c15

Anttila M, Penttilä J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. British Journal of Clinical Pharmacology [Internet]. Wiley; 2003 Aug 29;56(6):691–3. Available from: http://doi.org/10.1046/j.1365-2125.2003.01944.x DOI: https://doi.org/10.1046/j.1365-2125.2003.01944.x

Cimen ZS, Hanci A, Sivrikaya GU, Kilinc LT, Erol MK. Comparison of buccal and nasal dexmedetomidine premedication for pediatric patients. Lerman J, editor. Pediatric Anesthesia [Internet]. Wiley; 2012 Sep 18;23(2):134–8. Available from: http://doi.org/10.1111/pan.12025 DOI: https://doi.org/10.1111/pan.12025

Yuen VM, Hui TW, Irwin MG, Yuen MK. A Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Anesthesia: A Double-Blinded Randomized Controlled Trial. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 Jun;106(6):1715–21. Available from: http://doi.org/10.1213/ane.0b013e31816c8929 DOI: https://doi.org/10.1213/ane.0b013e31816c8929

Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine [Internet]. Ovid Technologies (Wolters Kluwer Health); 2002 Jan;30(1):119–41. Available from: http://doi.org/10.1097/00003246-200201000-00020 DOI: https://doi.org/10.1097/00003246-200201000-00020

Riker RR. Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients. JAMA [Internet]. American Medical Association (AMA); 2009 Feb 4;301(5):489. Available from: http://doi.org/10.1001/jama.2009.56

Ely EW. Delirium as a Predictor of Mortality in Mechanically Ventilated Patients in the Intensive Care Unit. JAMA [Internet]. American Medical Association (AMA); 2004 Apr 14;291(14):1753. Available from: http://doi.org/10.1001/jama.291.14.1753 DOI: https://doi.org/10.1001/jama.291.14.1753

Frontera JA. Delirium and sedation in the ICU. Neurocrit Care 2011;14:463-74. DOI: https://doi.org/10.1007/s12028-011-9520-0

Sanders RD, Maze M. Contribution of sedative-hypnotic agents to delirium via modulation of the sleep pathway. Canadian Journal of Anesthesia/Journal canadien d’anesthésie [Internet]. Springer Science and Business Media LLC; 2010 Dec 18;58(2):149–56. Available from: http://doi.org/10.1007/s12630-010-9421-2 DOI: https://doi.org/10.1007/s12630-010-9421-2

Borbély AA, Achermann P. Ultradian dynamics of sleep after a single dose of benzodiazepine hypnotics. European Journal of Pharmacology [Internet]. Elsevier BV; 1991 Mar;195(1):11–8. Available from: http://doi.org/10.1016/0014-2999(91)90376-2 DOI: https://doi.org/10.1016/0014-2999(91)90376-2

Huupponen E, maksimow A, lapinlampi P, Särkelä M, Saastamoinen A, Snapir A, et al. Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep. Acta Anaesthesiologica Scandinavica [Internet]. Wiley; 2008 Feb;52(2):289–94. Available from: http://doi.org/10.1111/j.1399-6576.2007.01537.x DOI: https://doi.org/10.1111/j.1399-6576.2007.01537.x

Riker RR. Dexmedetomidine vs Midazolam for Sedation of Critically Ill PatientsA Randomized Trial. JAMA [Internet]. American Medical Association (AMA); 2009 Feb 4;301(5):489. Available from: http://doi.org/10.1001/jama.2009.56 DOI: https://doi.org/10.1001/jama.2009.56

Pandharipande PP, Pun BT, Herr DL, Maze M, Girard TD, Miller RR, et al. Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients. JAMA [Internet]. American Medical Association (AMA); 2007 Dec 12;298(22):2644. Available from: http://doi.org/10.1001/jama.298.22.2644 DOI: https://doi.org/10.1001/jama.298.22.2644

Soo-Bong Yu. Dexmedetomidine sedation in ICU. Korean J Anesthesiol 2012 May;62(5):405-411 DOI: https://doi.org/10.4097/kjae.2012.62.5.405

Дексмедетомідин для седації в інтенсивній терапії.

Published

2020-06-01

How to Cite

1.
Dmytriiev D, Bortnik D, Rudnitsky Y, Heranin S, Korenchuk N. Dexmedetomidine for sedation in intensive care. Literature review and clinical experience. prmd [Internet]. 2020 Jun. 1 [cited 2023 Jun. 1];3(1):33-9. Available from: https://perioperative.org.ua/index.php/prtmdc/article/view/44

Issue

Section

Clinical thinking

Most read articles by the same author(s)