Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting

@article{Keating2015DexmedetomidineAR,
  title={Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting},
  author={Gillian M. Keating},
  journal={Drugs},
  year={2015},
  volume={75},
  pages={1119-1130}
}
Dexmedetomidine (Dexdor®) is a highly selective α2-adrenoceptor agonist. It has sedative, analgesic and opioid-sparing effects and is suitable for short- and longer-term sedation in an intensive care setting. In the randomized, double-blind, multicentre MIDEX and PRODEX trials, longer-term sedation with dexmedetomidine was noninferior to midazolam and propofol in terms of time spent at the target sedation range, as well as being associated with a shorter time to extubation than midazolam or… 
A Review of the Clinical Uses of Dexmedetomidine
Dexmedetomidine is highly selective α2A adrenergic receptor agonist approved for shortterm sedation in an intensive care unit (ICU) setting or in non-intubated patients prior to and/or during
Early Sedation with Dexmedetomidine in Critically Ill Patients.
TLDR
Among patients undergoing mechanical ventilation in the ICU, those who received early dexmedetomidine for sedation had a rate of death at 90 days similar to that in the usual-care group and required supplemental sedatives to achieve the prescribed level of sedation.
Standard- versus High-Dose Dexmedetomidine for Sedation in the Intensive Care Unit
TLDR
It is added to the literature that administration of high-dose dexmedetomidine does not appear to confer additional benefit over standard doses for ICU patients requiring mechanical ventilation, and application of this data may support lower institutional maximum doses.
Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia.
TLDR
The benefits of dexmedetomidine in critically ill patients and in cardiac, electrophysiology-related, vascular, and thoracic procedures are discussed.
Pharmacy-Driven Dexmedetomidine Stewardship and Appropriate Use Guidelines in a Community Hospital Setting
TLDR
Pharmacy-driven dexmedetomidine appropriate use guidelines decreased the use of dexmedETomidine and increased cost savings at a community hospital without adversely affecting clinical outcomes.
Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit
TLDR
There was a significant difference between the two groups in terms of the incidence of delirium and the level of agitation; the patients in the dexmedetomidine group were calmer and experienced less deliria.
Use of Dexmedetomidine in Transfemoral Transcatheter Aortic Valve Implantation (tf-TAVI) Procedures
TLDR
Sedation with dexmedetomidine for TAVI procedures with femoral access was proven effective and safe and may be a valid alternative to general anesthesia in high-risk older patients undergoing transfemoral TAVi.
Comparative evaluation of midazolam, dexmedetomidine, and propofol as Intensive Care Unit sedatives in postoperative electively ventilated eclamptic patients
TLDR
Sedation with dexmedetomidine produced better hemodynamic stability in eclamptic patients, and there was a significant reduction in requirement of additional analgesics and antihypertensive requirements of such patients admitted to Intensive Care Unit (ICU) after termination of pregnancy.
Dexmedetomidine-Associated Hyperthermia: A Series of 9 Cases and a Review of the Literature
TLDR
It is suggested that dexmedetomidine administration may be associated with the occurrence of clinically relevant hyperthermia, and the underlying mechanisms and risk factors are uncertain and require further research.
Reconsidering Dexmedetomidine for Sedation in the Critically Ill: Implications of the SPICE III Trial
TLDR
An editorial examines the merits of the SPICE III trial and the role of dexmedetomidine in practice following its publication, and the results of this trial have both validated and contradicted previous findings.
...
1
2
3
4
5
...

References

SHOWING 1-10 OF 62 REFERENCES
Dexmedetomidine: a review of its use for sedation in mechanically ventilated patients in an intensive care setting and for procedural sedation.
TLDR
Intravenous dexmedetomidine provides a further option as a short-term (<24 hours) primary sedative in mechanically ventilated adult patients in an intensive care setting and in non-intubated adult patients prior to and/or during surgical and other procedures.
Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials.
TLDR
Among ICU patients receiving prolonged mechanical ventilation, dexmedetomidine was not inferior to midazolam and propofol in maintaining light to moderate sedation and improved patients' ability to communicate pain.
Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: patient and clinician perceptions.
TLDR
Despite ventilation and intubation, patients sedated with dexmedetomidine could be easily roused to cooperate with procedures (e.g. physiotherapy, radiology) without showing irritation.
The Role of the α2-Adrenoceptor Agonist Dexmedetomidine in Postsurgical Sedation in the Intensive Care Unit
TLDR
Continuously given throughout the ICU stay, dexmedetomidine had no effect on respiratory rate, oxygen saturation, duration of weaning, or times to extubation, and Nurses judged the dexmedETomidine patients were easier to manage.
Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial
IntroductionAgitated delirium is common in patients undergoing mechanical ventilation, and is often treated with haloperidol despite concerns about safety and efficacy. Use of conventional sedatives
The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit.
TLDR
Continuously given throughout the ICU stay, dexmedetomidine had no effect on respiratory rate, oxygen saturation, duration of weaning, or times to extubation, and Nurses judged the dexmedETomidine patients were easier to manage.
Role of Dexmedetomidine for the Prevention and Treatment of Delirium in Intensive Care Unit Patients
TLDR
Current available evidence suggests that dexmedetomidine is a promising agent, not only for prevention but also for treatment of ICU-associated delirium, however, larger, well-designed trials are warranted to define the role of dexmedETomidine in preventing and treatingDelirium in the ICU.
Dexmedetomidine versus standard care sedation with propofol or midazolam in intensive care: an economic evaluation
TLDR
From an economic point of view, dexmedetomidine appears to be a preferable option compared with standard sedatives for providing light to moderate ICU sedation exceeding 24 hours, with savings potential results primarily from shorter time to extubation.
Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation
TLDR
This pilot study suggests that in long-term sedation, DEX is comparable to SC in maintaining sedation targets of RASS 0 to −3 but not suitable for deep sedation (RASS −4 or less).
Comparison of clonidine and dexmedetomidine for short-term sedation of intensive care unit patients
  • U. Srivastava, M. Sarkar, +5 authors Yogita Dwivedi
  • Medicine
    Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
  • 2014
TLDR
Hemodynamic stability provided by dexmedetomidine gives it an edge over clonidine for short-term sedation of ICU patients, however, the hemodynamic stability given byClonidine gives the latter an edge for sedation in patients on mechanical ventilation.
...
1
2
3
4
5
...