Dexmedetomidine attenuates acute paroxysmal sympathetic hyperactivity

Abstract

We evaluated the curative effect of dexmedetomidine on paroxysmal sympathetic hyperactivity (PSH) in a retrospective study of 72 PSH patients after neurosurgery. Our results showed that dexmedetomidine was superior to propofol for treatment of PSH with respect to: average time needed to reduce paroxysmal hypertension (PH) to <140/90 mmHg (29.03±8.86 vs. 42.0±14.77 min), average remission time of PH (3.97±1.73 vs. 5.65±1.51 min), PH remission rate (61.22±10.8% vs. 41.52±14.15%), PH duration (9.31±2.66 vs. 13.05±4.19 days), average time for body temperature to return to normal (10.62±4.14 vs. 15.31±4.58 days), average time for heartrate to return to normal (11.34±3.90 vs. 15.72±4.10 days), and average time of respiratory rate below 25 breaths per minute (BPM) (7.00±1.74 vs. 15.32±5.87 days). Multiple logistic regression analyses showed that dexmedetomidine did not protect against the recurrence of PSH. Age and Glasgow Coma Score were the main factors predicting PSH recurrence. There was no difference in Glasgow Outcome Score (GOS) between the two groups during the 6 months of postoperative follow-up (p>0.05). These data suggest dexmedetomidine effectively controls an acute attack of PSH, but it does not improve the long-term prognosis of patients compared with propofol.

Management of Paroxysmal Sympathetic Hyperactivity with Dexmedetomidine and Propranolol Following Traumatic Brain Injury in a Pediatric Patient

“…In addition, dexmedetomidine has limited effects on respiratory drive and induces lighter sedation than comparative agents such as propofol or benzodiazepines. 26 Moreover, propranolol and dexmedetomidine both act systemically to modulate SNS outflow and reduce associated symptoms of PSH. 6,26 Concerns with using propranolol and dexmedetomidine in pediatric patients include bradycardia, hypotension, and decrease in CBF, however, these were not documented in our patient during treatment.…”

“…26 Moreover, propranolol and dexmedetomidine both act systemically to modulate SNS outflow and reduce associated symptoms of PSH. 6,26 Concerns with using propranolol and dexmedetomidine in pediatric patients include bradycardia, hypotension, and decrease in CBF, however, these were not documented in our patient during treatment. If any of these agents result in hemodynamic instability or compromise CBF in your patient, alternative agents should be chosen.…”

Paroxysmal Sympathetic Hyperactivity after Cardiac Arrest in a Young Male

“…Clonidine is available both in oral form and as a patch which makes its use even more practical. Dexmedetomidine, another presynaptic alpha 2 agonist, has been shown to be effective and in some reports even more effective than propofol in acute attacks [ 18 ]. Tang et al showed that dexmedetomidine can prevent the occurrence of PSH after TBI [ 19 ].…”

Using Heart Rate Variability Monitoring for Dexmedetomidine Dosing in Neurointensive Care Patients

“…Следует отметить, что применение шкалы RASS во многом субъективно, и у ряда пациентов с низким уровнем сознания (вегетативный статус, минимальное сознание) не позволяет воспользоваться приведенными в ней клиническими критериями при подборе дозы дексмедетомидина. Эти и другие факторы побуждают к поиску объективных критериев, основанных на оценке многократно воспроизводимых физиологических параметров для применения данного лекарственного препарата [5,6]. Представ-…”