Dexmedetomidine Controls Agitation and Facilitates Reliable, Serial Neurological Examinations in a Non-Intubated Patient with Traumatic Brain Injury

Abstract

Given the large numbers of alcohol-dependent patients who suffer a traumatic brain injury and subsequently develop agitation and alcohol withdrawal in hospital, dexmedetomidine offers a novel strategy to facilitate sedation without neurological or respiratory depression. As this case report demonstrates, dexmedetomidine is an emerging treatment option for agitation in patients who require reliable, serial neurological testing to monitor the course of their traumatic brain injury.

Review of adjunctive dexmedetomidine in the management of severe acute alcohol withdrawal syndrome

“…Tang et al evaluated the use of dexmedetomidine for management of agitation that was refractory to lorazepam in a patient with traumatic brain injury (TBI) (24). The patient was a 69-year-old man with a history of chronic alcohol use, admitted to the neurosurgical ICU after a fall.…”

“…Dexmedetomidine has been evaluated as a sedative in patients with alcohol abuse prior to active AWS, demonstrating variable effectiveness (20,21). Available literature regarding its use for management of active AWS includes case reports and series, retrospective analyses and a randomized controlled trial (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The purpose of this review is to provide current findings of published literature regarding the efficacy and safety of this adjunctive therapy in the management of AWS.…”

Effects of dexmedetomidine on cerebral blood flow in critically ill patients with or without traumatic brain injury: A prospective controlled trial

“…It can produce a state of tranquility and arousability that is associated with minimal respiratory depression [3]. These characteristics make it a potentially attractive therapeutic in many clinical situations, especially for sedation of neurocritical care patients for whom the maintenance of spontaneous respiration and frequent neurologic evaluation is of clinical importance [4,5]. Dexmedetomidine activates all three sub-types of a 2 adrenoceptors, which are present in high concentrations in vascular smooth muscle, as well as in key arousal areas of the central nervous system, such as the locus ceruleus [6].…”

Dexmedetomidine controls twitch-convulsive syndrome in the course of uremic encephalopathy

“…Dexmedetomidine does not bind to the GABA receptor and thus may minimize the development of delirium by decreasing the release of norepinephrine. Therefore, dexmedetomidine is an emerging treatment option for delirium in patients who require reliable, serial neurological testing [8,9,17].…”