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      Current role of dexmedetomidine in clinical anesthesia and intensive care

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          Abstract

          Dexmedetomidine is a new generation highly selective α2-adrenergic receptor (α2-AR) agonist that is associated with sedative and analgesic sparing effects, reduced delirium and agitation, perioperative sympatholysis, cardiovascular stabilizing effects, and preservation of respiratory function. The aim of this review is to present the most recent topics regarding the advantages in using dexmedetomidine in clinical anesthesia and intensive care, while discussing the controversial issues of its harmful effects.

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          The effects of increasing plasma concentrations of dexmedetomidine in humans.

          Thomas Ebert, Judith Hall, Jill A. Barney … (2000)
          This study determined the responses to increasing plasma concentrations of dexmedetomidine in humans. Ten healthy men (20-27 yr) provided informed consent and were monitored (underwent electrocardiography, measured arterial, central venous [CVP] and pulmonary artery [PAP] pressures, cardiac output, oxygen saturation, end-tidal carbon dioxide [ETCO2], respiration, blood gas, and catecholamines). Hemodynamic measurements, blood sampling, and psychometric, cold pressor, and baroreflex tests were performed at rest and during sequential 40-min intravenous target infusions of dexmedetomidine (0.5, 0.8, 1.2, 2.0, 3.2, 5.0, and 8.0 ng/ml; baroreflex testing only at 0.5 and 0.8 ng/ml). The initial dose of dexmedetomidine decreased catecholamines 45-76% and eliminated the norepinephrine increase that was seen during the cold pressor test. Catecholamine suppression persisted in subsequent infusions. The first two doses of dexmedetomidine increased sedation 38 and 65%, and lowered mean arterial pressure by 13%, but did not change central venous pressure or pulmonary artery pressure. Subsequent higher doses increased sedation, all pressures, and calculated vascular resistance, and resulted in significant decreases in heart rate, cardiac output, and stroke volume. Recall and recognition decreased at a dose of more than 0.7 ng/ml. The pain rating and mean arterial pressure increase to cold pressor test progressively diminished as the dexmedetomidine dose increased. The baroreflex heart rate slowing as a result of phenylephrine challenge was potentiated at both doses of dexmedetomidine. Respiratory variables were minimally changed during infusions, whereas acid-base was unchanged. Increasing concentrations of dexmedetomidine in humans resulted in progressive increases in sedation and analgesia, decreases in heart rate, cardiac output, and memory. A biphasic (low, then high) dose-response relation for mean arterial pressure, pulmonary arterial pressure, and vascular resistances, and an attenuation of the cold pressor response also were observed.
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            Dexmedetomidine: a novel sedative-analgesic agent.

            R Gertler, H Brown, D H Mitchell … (2001)
            Since the first report of clonidine, an alpha2-adrenoceptor agonist, the indications for this class of drugs have continued to expand. In December 1999, dexmedetomidine was approved as the most recent agent in this group and was introduced into clinical practice as a short-term sedative (<24 hours). Alpha2-adrenoceptor agonists have several beneficial actions during the perioperative period. They decrease sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery; reduce anesthetic and opioid requirements; and cause sedation and analgesia. They allow psychomotoric function to be preserved while letting the patient rest comfortably. With this combination of effects, alpha2-adrenoceptor agonists may offer benefits in the prophylaxis and adjuvant treatment of perioperative myocardial ischemia. Furthermore, their role in pain management and regional anesthesia is expanding. Side effects consist of mild to moderate cardiovascular depression, with slight decreases in blood pressure and heart rate. The development of new, more selective alpha2-adrenoceptor agonists with improved side effect profiles may provide a new concept for the administration of perioperative anesthesia and analgesia. This review aims to give background information to improve understanding of the properties and applications of the novel alpha2-adrenoceptor agonist, dexmedetomidine.
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              Clinical uses of alpha2 -adrenergic agonists.

              T Kamibayashi, M Maze (2000)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Anesth Essays Res
                Journal ID (iso-abbrev): Anesth Essays Res
                Journal ID (publisher-id): AER
                Title: Anesthesia, Essays and Researches
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0259-1162
                ISSN (Electronic): 2229-7685
                Publication date (Print): Jul-Dec 2011
                Volume: 5
                Issue: 2
                Pages: 128-133
                Affiliations
                [1]Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, J.P.N.A Trauma Centre, New Delhi, India
                [1 ]Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
                Author notes
                Corresponding author: Dr. Manpreet Kaur, Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A Trauma Centre, New Delhi - 110 029, India. E-mail: manpreetkaurrajpal@ 123456yahoo.com
                Article
                Publisher ID: AER-5-128
                DOI: 10.4103/0259-1162.94750
                PMC ID: 4173414
                PubMed ID: 25885374
                SO-VID: 9d2e040f-30fc-42a0-8994-5daabb88a951
                Copyright © Copyright: © Anesthesia: Essays and Researches
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Review Article

                Keywords: dexmedetomidine,intensive care unit sedation,α2-adrenergic receptor agonist
                Data availability:
                Keywords: dexmedetomidine, intensive care unit sedation, α2-adrenergic receptor agonist

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