Dexmedetomidine: an attractive adjunct to anesthesia

Bae, Hong-Beom

doi:10.4097/kjae.2017.70.4.375

Cited by 11 publications

(10 citation statements)

References 20 publications

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“…It has been approved by the U.S. Food and Drug Administration for short-term sedation (< 24 h) of initially intubated and mechanically ventilated adult patients in the intensive care unit (ICU) and for sedation of non-intubated patients during surgical and other procedures. Although dexmedetomidine is now widely used for the above indications in the ICU and the operating room [2], its clinical applications have been greatly expanded in recent decades due to many favorable physiological effects [3].…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine: present and future directions

Lee

2019

Korean J Anesthesiol

228

154

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Dexmedetomidine, a potent and highly selective α-2 adrenoceptor agonist, has been described as a unique sedative with analgesic, sympatholytic, and respiratory-preserving properties [1]. It has been approved by the U.S. Food and Drug Administration for short-term sedation (< 24 h) of initially intubated and mechanically ventilated adult patients in the intensive care unit (ICU) and for sedation of non-intubated patients during surgical and other procedures. Although dexmedetomidine is now widely used for the above indications in the ICU and the operating room [2], its clinical applications have been greatly expanded in recent decades due to many favorable physiological effects [3]. This review aims to summarize the current knowledge of dexmedetomidine and discuss its applications, including off-label use, in various clinical settings. Review Article Dexmedetomidine is a potent, highly selective α-2 adrenoceptor agonist, with sedative, analgesic, anxiolytic, sympatholytic, and opioid-sparing properties. Dexmedetomidine induces a unique sedative response, which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Dexmedetomidine may produce less delirium than other sedatives or even prevent delirium. The analgesic effect of dexmedetomidine is not strong; however, it can be administered as a useful analgesic adjuvant. As an anesthetic adjuvant, dexmedetomidine decreases the need for opioids, inhalational anesthetics, and intravenous anesthetics. The sympatholytic effect of dexmedetomidine may provide stable hemodynamics during the perioperative period. Dexmedetomidine-induced cooperative sedation with minimal respiratory depression provides safe and acceptable conditions during neurosurgical procedures in awake patients and awake fiberoptic intubation. Despite the lack of pediatric labelling, dexmedetomidine has been widely studied for pediatric use in various applications. Most adverse events associated with dexmedetomidine occur during or shortly after a loading infusion. There are some case reports of dexmedetomidine-related cardiac arrest following severe bradycardia. Some extended applications of dexmedetomidine discussed in this review are promising, but still limited, and further research is required. The pharmacological properties and possible adverse effects of dexmedetomidine should be well understood by the anesthesiologist prior to use. Moreover, it is necessary to select patients carefully and to determine the appropriate dosage of dexmedetomidine to ensure patient safety.

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Section: Introductionmentioning

confidence: 99%

Dexmedetomidine: present and future directions

Lee

2019

Korean J Anesthesiol

228

154

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“…The α 2 -adrenoceptor plays an important role in antinociception, and α 2 -adrenoceptor agonists attenuate hypersensitivity under neuropathic conditions [ 5 6 7 ]. There are three highly homologous subtypes of the α 2 -adrenoceptor: α 2 A, α 2 B, and α 2 C. Dexmedetomidine, a highly selective α 2 -adrenoceptor agonist, has been used for conscious sedation and as an adjunct for clinical anesthesia [ 8 9 10 ]. In animal experiments, dexmedetomidine has been shown to produce analgesic effects in models of neuropathic pain, but the mechanisms underlying these effects remain largely unknown [ 11 12 13 ].…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine Attenuates Neuropathic Pain by Inhibiting P2X7R Expression and ERK Phosphorylation in Rats

et al. 2018

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α2-Adrenoceptor agonists attenuate hypersensitivity under neuropathic conditions. However, the mechanisms underlying this attenuation remain largely unknown. In the present study, we explored the potential roles of purinergic receptor 7 (P2X7R)/extracellular signal-regulated kinase (ERK) signaling in the anti-nociceptive effect of dexmedetomidine in a rat model of neuropathic pain induced by chronic constriction injury (CCI) of the sciatic nerve. An animal model of CCI was adopted to mimic the clinical neuropathic pain state. Behavioral hypersensitivity to mechanical and thermal stimuli was determined by von Frey filament and Hargreaves' tests, and the spinal P2X7R expression level and ERK phosphorylation were analyzed using western blot analysis and immunohistochemistry. In parallel with the development of mechanical and thermal hyperalgesia, a significant increase in P2X7R expression was noted in the ipsilateral spinal cord on day 7 after CCI. Intrathecal administration of dexmedetomidine (2.5 µg) for 3 days not only attenuated neuropathic pain but also inhibited the CCI-induced P2X7R upregulation and ERK phosphorylation. Intrathecal dexmedetomidine administration did not produce obvious effects on locomotor function. The present study demonstrated that dexmedetomidine attenuates the neuropathic pain induced by CCI of the sciatic nerve in rats by inhibiting spinal P2X7R expression and ERK phosphorylation, indicating the potential therapeutic implications of dexmedetomidine administration for the treatment of neuropathic pain.

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“…However, the duration of the local anesthetic itself, such as ropivacaine, is limited to 8–14 h and the rebound pain after the nerve block wears off diminishes the analgesic benefit of the nerve block [10]. Dexmedetomidine, an α2 adrenergic receptor agonist developed as a short-term sedative [11], has shown sympatholytic, analgesic, and opioid-sparing effects, whilst adjuvant dexmedetomidine has been found to improve the duration and quality of nerve block [12,13,14].…”

Section: Introductionmentioning

confidence: 99%

Thoracic Paravertebral Block with Adjuvant Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind Study

Hong

Lim

Kang

et al. 2019

JCM

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Background: The addition of the adjuvant dexmedetomidine to a nerve block improves the quality of the block and reduces perioperative opioid consumption. The aim of this study was to assess the effect of dexmedetomidine as an adjuvant for the thoracic paravertebral block (TPVB) in postoperative pain control after video-assisted thoracoscopic surgery (VATS). Methods: Sixty-six males, aged 15–40 years, with spontaneous pneumothorax scheduled for VATS wedge resection were enrolled. Following surgery, ultrasound-guided TPVB was performed on the T3 and T5 levels with 30 mL of 0.5% ropivacaine, plus adjuvant dexmedetomidine 50 μg or normal saline. The primary outcome was cumulative fentanyl consumption at 24 h. Pain severity, the requirement for additional rescue analgesics, hemodynamic variations, and side effects were also evaluated. Results: Median postoperative cumulative fentanyl consumption at 24 h was significantly lower in the dexmedetomidine group (122.6 (interquartile range (IQR) 94.5–268.0) μg vs. 348.1 (IQR, 192.8–459.2) μg, p-value = 0.001) with a Hodges–Lehman median difference between groups of 86.2 (95% confidence interval (CI), 4.2–156.4) mg. Coughing numeric rating scale (NRS) was lower in the dexmedetomidine group at postoperative 2, 4, 8, and 24 h. However, resting NRS differed significantly only after 4 h postoperative. Conclusions: Dexmedetomidine as an adjunct in TPVB provided effective pain relief and significantly reduced opioid requirement in VATS.

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Dexmedetomidine: an attractive adjunct to anesthesia

Cited by 11 publications

References 20 publications

Dexmedetomidine: present and future directions

Dexmedetomidine: present and future directions

Dexmedetomidine Attenuates Neuropathic Pain by Inhibiting P2X7R Expression and ERK Phosphorylation in Rats

Thoracic Paravertebral Block with Adjuvant Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind Study

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