Dexmedetomidine for Alcohol Withdrawal Syndrome

Linn, Dustin; Loeser, Kathryn C.

doi:10.1177/1060028015607038

Cited by 33 publications

(24 citation statements)

References 26 publications

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“…The adjunctive use of dexmedetomidine in alcohol withdrawal syndrome has been shown to reduce hypertension and tachycardia and to decrease the required benzodiazepine dosages during the withdrawal 23. Positive effects of pre- or peri-procedural dexmedetomidine administration in ECT on PIA have been reported in case reports in combination with methohexital and propofol anesthesia and in randomized controlled trials with propofol and ketofol (ketamine–propofol combination) anesthesia 10,11,24.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

Aksay¹,

Bumb²,

Remennik³

et al. 2017

NDT

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ObjectivesPostictal agitation (PIA) represents one of the most common complications during a modified electroconvulsive therapy (ECT) course. Its clinical management can be challenging especially in cases with poor response to benzodiazepines. Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist acting predominantly in the locus coeruleus, exerts sedative effects without causing relevant respiratory depression. To the best of our knowledge, this is the first study that aimed to assess the impact of dexmedetomidine use with S-ketamine anesthesia on PIA reduction in ECT.Patients and methodsWe retrospectively analyzed 7 patients who underwent 178 ECT sessions with S-ketamine anesthesia between June 2011 and July 2015 at the Central Institute of Mental Health Mannheim. In 101 sessions, the patients received dexmedetomidine in combination with S-ketamine anesthesia. The decision for dexmedetomidine use was based on individual clinical presentation (patients with positive PIA history). A multivariate repeated measurement logistic regression analysis was conducted to investigate the effect of dexmedetomidine use on the occurrence of PIA. We hypothesized that the use of dexmedetomidine reduced the incidence of PIA also in combination with S-ketamine anesthesia.ResultsThe prevalence of PIA in ECT sessions with dexmedetomidine administration was lower (mean per patient, 34% vs 62%). In the multivariate logistic regression analysis, the use of dexmedetomidine predicted the non-occurrence of PIA in a highly significant manner (P=0.001, z=−3.83, odds ratio =0.011–0.303).ConclusionAdjunctive use of dexmedetomidine to S-ketamine anesthesia in ECT seems to be a promising tool for the management of intractable PIA syndrome.

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Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

Aksay¹,

Bumb²,

Remennik³

et al. 2017

NDT

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“…Due to its rapid onset of action and short half‐life, it produces a “cooperative sedation” without necessity for intubation. As ɑ‐2 agonists lack the GABAergic activity to prevent and treat DT or seizures, they can only be used as adjunctive therapy to reduce autonomic hyperactivity that cannot be controlled by BZD alone 3, 80, 86. Several studies demonstrated a BZD‐sparing effect with significant reduction in BZD requirement 87, 88, 89…”

Section: Therapymentioning

confidence: 99%

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

et al. 2016

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The alcohol withdrawal syndrome is a well‐known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. The purpose of this review is to increase the awareness of the early clinical manifestations of AWS and the appropriate identification and management of this important condition in a neurological setting.

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“…Die Nutzung von Dexmedetomidin in der Therapie des akuten Alkoholentzugsdelirs wurde binnen der vergangenen zwei Jahre in mehreren kleinen Fallserien beschrieben [9]. Aktuell liegen sechs retrospektive Übersichten, eine prospektive Observationsstudie und eine PRCT (Prospective Randomized Controlled Trial) vor [4,6,10,11,13,16,19,20].…”

Section: Dexmedetomidin Und Alkoholentzugsdelirvorliegende Evidenzunclassified

Dexmedetomidin in der Therapie des akuten Alkoholentzugsdelirs

2016

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Alcohol withdrawal syndrome has a high clinical prevalence. Severe cases must be treated in an intensive care unit and are associated with a high mortality rate, depending on patient comorbidities. Clinical requirements include sedation, control of vegetative symptoms, treatment of hallucinations and, when necessary, anticonvulsive therapy. Currently, there is no single substance that fulfills these requirements. National and international guidelines recommend a combination of various substances. The central α2-adrenergic receptor agonist clonidine is used as a therapeutic adjuvant. In consideration of its pharmacological characteristics, dexmedetomidine is assumed to be more advantageous compared to clondine. Case studies with dexmedetomidine in alcohol withdrawal syndrome show the safety of its application and a benzodiazepine-sparing effect. Its incorporation in escalating intensive care therapy of severe cases could be appropriate.

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Dexmedetomidine for Alcohol Withdrawal Syndrome

Cited by 33 publications

References 26 publications

Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

Dexmedetomidine for the management of postictal agitation after electroconvulsive therapy with S-ketamine anesthesia

Alcohol withdrawal syndrome: mechanisms, manifestations, and management

Dexmedetomidin in der Therapie des akuten Alkoholentzugsdelirs

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