Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal*

Shutes, Brittany L; Gee, Samantha W.; Sargel, Cheryl; Fink, Kelsey A; Tobias, Joseph D.

doi:10.1097/pcc.0000000000001451

Cited by 62 publications

(54 citation statements)

References 17 publications

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“…Researchers reported in the literature that doses of 1-4 μg/ kg of dexmedetomidine may cause a temporary increase in blood pressure and reflex bradycardia. Peripheral vasoconstriction due to α2β receptor activation in peripheral arteriol smooth muscles and subsequent sympatholytic effect due to activation of α2C receptors are responsible for suppressing noradrenaline release by "negative feedback"mechanism [19][20][21][22] . Bloor et al reported a 2-minute infusion of dexmedetomidine at a dose of 1 μg/kg and a significant increase in MAP compared to baseline values in the subsequent first minute [23] .…”

Section: Discussionmentioning

confidence: 99%

The effects of dexmedetomidine on hemodynamic parameters and intubation conditions

Ar¹

2018

Haydarpasa Numune Med J

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Introduction: In this study, we aim to investigate the effects of two different preanesthetic doses of dexmedetomidine on the hemodynamic response to endotracheal intubation, intubation conditions and neuromuscular block. Methods: Seventy-five ASAI-II patients, aged 18-70 years, who required tracheal intubation for elective surgery were allocated for this study. Before induction, patients were randomly divided into three groups to receive either saline as placebo (20cc) (GroupC), dexmedetomidine 0.5 μg/kg (Group D0.5) or dexmedetomidine 1 μg/kg (Group D1) in a total volume of 20 cc in 10 min. Heart rate(HR) and mean arterial pressure (MAP) were recorded according to the study's measurement time. Time to achieve 90% and 100% neuromuscular block, time to recovery from neuromuscular block 25% (T25), 50% (T50), 75% (T75) and recovery index values were noted. Results: The increases in HR after laryngoscopy and immediately intubation were lower in both groups D than Group C. Values of MAP during laryngoscopy were lower in both Groups D than Group C Times to achieve 90% and 100% neuromuscular block were found significantly lower in dexmedetomidine groups than Group C. Values of T75 and recovery index in Group D 0.5, T25, T50, T75 and recovery index in Group D1 were longer than Group C. Neuromuscular block properties were similar between dexmedetomidine groups. Discussion and Conclusion: We conclude that dexmedetomidine decreased hemodynamic response to endotracheal intubation, especially heart rate dose-dependently, whereas it decreased time to achieve neuromuscular block and increased time to recovery from the neuromuscular block as independent from dose.

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Section: Discussionmentioning

confidence: 99%

The effects of dexmedetomidine on hemodynamic parameters and intubation conditions

Ar¹

2018

Haydarpasa Numune Med J

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“…An alternative strategy to prevent DEX withdrawal symptoms involves transitioning DEX to enteral clonidine, another α-2 agonist. [17][18][19][20] Clonidine has been used to prevent and treat withdrawal symptoms associated with several classes of drugs including opioids, alcohol, and nicotine. 15,[21][22][23] It also provides adequate sedation for patients in the PICU and is well tolerated.…”

Section: Introductionmentioning

confidence: 99%

The Impact of a Clonidine Transition Protocol on Dexmedetomidine Withdrawal in Critically Ill Pediatric Patients

Liu¹,

Miller²,

Ferguson³

et al. 2020

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES This study describes our experience with a clonidine transition protocol to prevent dexmedetomidine (DEX) withdrawal in critically ill pediatric patients. METHODS Retrospective review of electronic medical records of patients in the pediatric intensive care unit of a single tertiary children's hospital. All patients up to 19 years of age, who received concomitant DEX infusion and enteral clonidine between June 1, 2016, and May 31, 2018, were included. RESULTS Two of 24 encounters had DEX restarted for withdrawal (8.3%). Five of 14 encounters who were transitioned to clonidine 2 mcg/kg every 6 hours required an increased dose, and 1 of 10 encounters transitioned to clonidine 4 mcg/kg every 6 hours required an increased dose (36% vs 10%, p = 0.21). For encounters with clonidine dose increases, 5 of 6 had improvements in Withdrawal Assessment Tool-1 (WAT-1) scores. Of these 5 encounters, 4 had decreasing or stable opioid and sedative requirements and 1 was transitioned to methadone. No encounters required discontinuation of clonidine owing to adverse events. Two of 24 encounters met our safety endpoint. One received a fluid bolus during the clonidine transition with no change in clonidine dosing, while the other had clonidine dose decreased for asymptomatic bradycardia. CONCLUSIONS The 24 encounters in our retrospective study add to the limited literature available to describe dosing, initiation time, and duration of clonidine to prevent withdrawal from DEX in critically ill pediatric patients. Further research is needed to clarify the optimal dosing and duration of clonidine to prevent DEX withdrawal in pediatric patients.

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“…Dexmedetomidine is a α2-receptor agonist which provides sedation and analgesia, and it can also reduce heart rate and blood pressure without respiratory depression [3] . Dexmedetomidine can improve postoperative cognitive function and reduce the incidence of early postoperative cognitive dysfunction [4] .…”

Section: Introductionmentioning

confidence: 99%

Early cognitive function changes after dexmedetomidine added to propofol-based sedation for gastrointestinal endoscopy

Chen

Lin

et al. 2019

Preprint

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Background: Propofol usually used for sedation for gastrointestinal endoscopy, result in short-term, reversible decline in cognitive function. This prospective cohort trial aimed to propofol plus dexmedetomidine can improve cognitive function for elective outpatient gastrointestinal endoscopy. Methods: Patients undergoing gastrointestinal endoscopy were included. Patients were randomized allocation into group C (groupC30 and groupC60), and group D. The group D was The group D was a continuous intravenous pumping of dexmedetomidine at a dose of 0.3μg/kg within 10min before anaesthesia; the group C were given an equal volume of normal saline instead. Patients underwent a MoCA test before sedation and at discharge. Results: The MoCA scores were similar at baseline in each group. Compared to baseline before gastrointestinal endoscopy, the MoCA scores were decreased each group ( group C30: p<0.001; group C60: p<0.001; group D: p=0.002). Compared to group C30, the MoCA scores were better in group C60 (p=0.03) and group D (p<0.001), and those in group D were higher than those in group C60 (p<0.001). Incidence of cognitive impairment in group C30 is 56.6% which ranks the highest among the three groups, and those in group D is 7.8% which ranks the lowest among the three groups, the difference is significant statistically (p<0.001). The MoCA scores were similar between the genders in each group (p>0.05). Conclusions: Dexmedetomidine added to sedation for gastrointestinal endoscopy can improve early cognitive function and reduce incidence of cognitive impairment.

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Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal*

Cited by 62 publications

References 17 publications

The effects of dexmedetomidine on hemodynamic parameters and intubation conditions

The effects of dexmedetomidine on hemodynamic parameters and intubation conditions

The Impact of a Clonidine Transition Protocol on Dexmedetomidine Withdrawal in Critically Ill Pediatric Patients

Early cognitive function changes after dexmedetomidine added to propofol-based sedation for gastrointestinal endoscopy

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