Influence of Cardiac Output on Dexmedetomidine Pharmacokinetics

Dutta, Sandeep; Lal, Ritu; Karol, Michael D.; Cohen, Theodora; Ebert, Thomas J.

doi:10.1002/(sici)1520-6017(200004)89:4<519::aid-jps9>3.0.co;2-u

Cited by 106 publications

(97 citation statements)

References 8 publications

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“…Bloor et al 37 reported that cardiac output decreased in a dose-dependent manner when more than 0.5 μg･kg -1 DEX was administered, and the decrease was by approximately 41% at a dosage of 2 μg･kg -1 . Ebert et al 38 and Dutta et al 39 reported that DEX decreased cardiac output in a plasma concentration-dependent manner.…”

Section: Discussionsupporting

confidence: 93%

Dexmedetomidine Dose Dependently Decreases Oral Tissue Blood Flow During Sevoflurane and Propofol Anesthesia in Rabbits

Sazuka

Matsuura

Ichinohe

2012

Journal of Oral and Maxillofacial Surgery

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Purpose: The aim of this study was to investigate the effect of dexmedetomidine (DEX) continuous infusion on blood flow in rabbit oral tissues during sevoflurane or propofol anesthesia.Methods: Twenty-four male tracheotomized Japan White rabbits were anesthetized with sevoflurane or propofol under mechanical ventilation. An initial loading dose of 6.0 μg･kg -1 ･hr -1 DEX was administered over 10 minutes. DEX was then maintained at

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Section: Discussionsupporting

confidence: 93%

Dexmedetomidine Dose Dependently Decreases Oral Tissue Blood Flow During Sevoflurane and Propofol Anesthesia in Rabbits

Sazuka

Matsuura

Ichinohe

2012

Journal of Oral and Maxillofacial Surgery

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“…The metabolism of DEX is dependent upon hepatic blood perfusion because of the high hepatic extraction ratio 7) as with propofol. Enlarged liver mass caused by obesity 8) results in increased hepatic blood flow and more hepatic extraction 9) , which might enhance the increased administered DEX dose associated with the increase of BMI (and its constitute TBW) in this study.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Obesity on Dose of Dexmedetomidine When Administered With Fentanyl During Postoperative Mechanical Ventilation - Retrospective

Obara

Morimoto

Iseki

et al. 2015

FJMS

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: We carried out a retrospective investigation on the effect of obesity on dexmedetomidine (DEX) requirements when administered with fentanyl (FEN) during mechanical ventilation after major surgeries. After Institutional Review Board approval, 14 obese patients with a body mass index (BMI) ≥ 30 kg/m 2 and the same number of non -obese patients with similar backgrounds to the obese patients were selected from medical records. Doses of DEX in the first 48 h or until the end of sedation or extubation were calculated for comparison. In addition to comparison of dosing between the groups, associations between total body weight (TBW), BMI, and lean body mass (LBM) values and doses of DEX (mcg/h), between BMI and various indices (i.e., amount per TBW per hour and amount per LBM per hour) of DEX doses, and between above indices of DEX and FEN doses were also examined. There were no significant differences in DEX dose indices between the groups. However, DEX requirements (mcg/h) were significantly increased with TBW (kg) (r = 0.51, P = 0.003), BMI (r = 0.49, P = 0.006) and LBM (kg) (r = 0.42, P = 0.02), which might have enhanced the DEX metabolism with physiological changes with obesity. These findings will be beneficial for future clinical pharmacological analysis of DEX.

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“…Iirola et al found that the clearance rate in an 80‐year‐old subject was about 25% lower than that in a 60‐year‐old subject; they also found that the elimination half‐life and context‐sensitive half‐time of dexmedetomidine were prolonged in their elderly patients 13. Third, the prevalence of underlying comorbidities is higher, and physiological reserves are lower (in terms of body weight, cardiac output, and plasma albumin level) in older patients compared with their younger counterparts;13, 14, 15, 26 this may also affect the pharmacokinetics of dexmedetomidine.…”

Section: Discussionmentioning

confidence: 98%

“…As a result, dexmedetomidine overdose might be poorly tolerated by elderly patients. Moreover, dexmedetomidine clearance decreases with increasing age and decreasing cardiac output 13, 14, 15. However, the effects of age on dexmedetomidine sedation among elderly populations remain controversial.…”

mentioning

confidence: 99%

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

Wang

Zhang

2018

Acta Anaesthesiol Scand

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BackgroundThe median effective dose (ED 50) of sedative dexmedetomidine adjuvant to peripheral nerve block (PNB) has not yet been verified in elderly patients. This study assessed the ED 50 of intravenous dexmedetomidine for sedation in elderly patients who were undergoing total knee arthroplasty (TKA) with PNB.MethodsForty‐two patients aged 65–85 years were included and stratified into two groups according to age: young‐old group (aged 65–74 years) and middle‐old group (aged 75–85 years). After the PNB was performed, a pre‐calculated dose of dexmedetomidine was administered for 10 min. The Observer's Assessment of Alertness/Sedation scale, bispectral index score, blood pressure and heart rate were recorded. ED 50 values of dexmedetomidine for adequate sedation were estimated by the up‐and‐down method of Dixon and probit regression.ResultsThe ED 50 of single‐dose dexmedetomidine adjuvant to PNB was 0.57 μg/kg (95% confidence interval [CI], 0.47–0.65) in the young‐old group and 0.38 μg/kg (95% CI, 0.28–0.46) in the middle‐old group. The ED 50 of dexmedetomidine differed significantly between the two groups (P < 0.001). In addition, no significant adverse hemodynamic or hypoxemic effects were noted.ConclusionWe determined the ED 50 for sedation using intravenous dexmedetomidine adjuvant to PNB in elderly patients. The ED 50 of dexmedetomidine in the middle‐old group decreased by 33% compared with that in the young‐old group with a mean age difference of 11 years between the two groups.

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Influence of Cardiac Output on Dexmedetomidine Pharmacokinetics

Cited by 106 publications

References 8 publications

Dexmedetomidine Dose Dependently Decreases Oral Tissue Blood Flow During Sevoflurane and Propofol Anesthesia in Rabbits

Dexmedetomidine Dose Dependently Decreases Oral Tissue Blood Flow During Sevoflurane and Propofol Anesthesia in Rabbits

The Effect of Obesity on Dose of Dexmedetomidine When Administered With Fentanyl During Postoperative Mechanical Ventilation - Retrospective

Effective dose of dexmedetomidine as an adjuvant sedative to peripheral nerve blockade in elderly patients

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