Safe and Efficacious Use of Dexmedetomidine over a Prolonged Duration for Anxiolysis and as an Adjunct to Analgesia during End-of-Life Care

Majumdar, Mainak; Wilks, Bernadette; Charlesworth, D.

doi:10.1177/082585971503100409

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…According to the title of their publication Majumdar et al (63) used dexmedetomidine for "prolonged duration for anxiolysis (…) during end-of-life care". The patient was a 52-year-old man with relapse T-cell-reich diffuse large B-cell lymphoma stage IV who failed a range of different therapies including R-CHOP, stem-cell-transplantation and others.…”

Section: Other Indications and Findings From Pediatric Palliative Carementioning

confidence: 99%

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Gaertner¹,

Fusi-Schmidhauser²

2022

Ann Palliat Med

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Background and Objective: Dexmedetomidine is a potent adrenergic alpha-2 receptor agonist. It was first approved for sedation for mechanically ventilated patients. Being a sedative medication that is not associated with respiratory depression and holding analgesic properties fosters the interest for this drug in the palliative care field. The primary objectives of this review were to identify the key indications for the real-world use of dexmedetomidine in palliative care and other disciplines.Methods: A narrative review after extensive PubMed search was performed from 1950 to present on October 21st 2021. The language of the publications was restricted to English, German, French and Italian.Key Content and Findings: (I) Current dexmedetomidine use. There is a growing body of evidence that dexmedetomidine may reduce the incidence and severity of delirium, reduce opioid-consumption and postoperative nausea in intensive care settings. It is also used to facilitate withdrawal from different substances (alcohol, opioids, heroin). Concerning safety aspects of the drug, some studies reported an increased rate of serious cardiovascular events in patients with pre-existing heart conditions due to bradycardia and arterial hypo-and hypertension. Since the drug has a main hepatic metabolism, dose reduction is mandatory in patients with hepatic impairment. (II) Dexmedetomidine and palliative care. There have been sporadic case reports about the successful use of dexmedetomidine in palliative care. Indications for symptom control included sedation for hyperactive delirium, cancer pain, opioid-induced-hyperalgesia, dystonia, cough, vomiting, shivering and dyspnea. It is mainly applied via the intravenous (i.v.), subcutaneous, but also nasal and, buccal routes. Admixture ("syringe-driver") studies showed that dexmedetomidine is compatible with morphine, hydromorphone, hyoscine and haloperidol. In 2021, a first prospective cohort study became available. Here, the authors reported promising result for dexmedetomidine use in hyperactive terminal delirium for reducing delirium intensity and agitation. Especially the unique "conscious sedation"or "awake sedation" that allows patients to arouse easily under sedation and report comfort or distress was discussed by the authors. Conclusions:In this review, we present the main findings for dexmedetomidine from palliative care settings and other disciplines. The potential benefits and criticalities of the drug are discussed and practical recommendations for its use are provided.

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Section: Other Indications and Findings From Pediatric Palliative Carementioning

confidence: 99%

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Gaertner¹,

Fusi-Schmidhauser²

2022

Ann Palliat Med

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“…Com relação ao tempo de uso, Yamout et al (2021), Majumdar, Wilks, Charlesworth (2015) Apesar desses supostos benefícios, potenciais efeitos colaterais devem ser considerados antes do uso da dexmedetomidina como terapia em sedação paliativa. Vale ressaltar, que essa droga pode ter efeitos cardíacos significativos, como hipotensão e bradicardia.…”

Section: Discussionunclassified

Efeitos do uso de dexmedetomidina na sedação paliativa de pacientes em fim de vida: revisão sistemática

Dos Santos,

De Oliveira

2024

Braz. J. Hea. Rev.

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Objetivo: Revisar na literatura os efeitos do uso de dexemedetomedina para sedação paliativa de pacientes em fim de vida. Método: Trata-se de uma revisão sistemática, sendo que este estudo adotou os critérios do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Uma busca sistemática foi realizada nas seguintes bases de dados: Medical Literature Analysis and Retrieval System Online (Medline/Pubmed) e a Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Resultados: A partir do aspecto de elegibilidade para a revisão, foram selecionados e apresentados 8 artigos. Conclusão: De acordo com os estudos pesquisados, a dexmedetomidina como agente sedativo induz um estado semelhante ao sono, permitindo um despertar rápido, além de fornecer analgesia, alívio da ansiedade e diminuição do delirium. Portanto, é uma opção eficaz na sedação paliativa de pacientes em fim de vida, principalmente se o cuidado padrão não foi eficaz.

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“…In addition, epidural anesthetics may infiltrate into the subarachnoid space and cause total spinal anesthesia or respiratory inhibition. Dexmedetomidine has been effectively used in minimally invasive surgeries 13 . The results in the current study are consistent with the literature; dexmedetomidine was shown to provide effective sedation and analgesia without affecting communication between the physician and patient.…”

Section: Discussionmentioning

confidence: 99%

Comparison of different anesthesia modalities during percutaneous kyphoplasty of osteoporotic vertebral compression fractures

Gao

et al. 2021

Sci Rep

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Local and general anesthesia are the main techniques used during percutaneous kyphoplasty (PKP); however, both are associated with adverse reactions. Monitored anesthesia with dexmedetomidine may be the appropriate sedative and analgesic technique. Few studies have compared monitored anesthesia with other anesthesia modalities during PKP. Our aim was to determine whether monitored anesthesia is an effective alternative anesthetic approach for PKP. One hundred sixty-five patients undergoing PKP for osteoporotic vertebral compression fractures (OVCFs) were recruited from a single center in this prospective, non-randomized controlled study. PKP was performed under local anesthesia with ropivacaine (n = 55), monitored anesthesia with dexmedetomidine (n = 55), and general anesthesia with sufentanil/propofol/sevoflurane (n = 55). Perioperative pain was assessed using a visual analogue score (VAS). Hemodynamic variables, operative time, adverse effects, and perioperative satisfaction were recorded. The mean arterial pressure (MAP), heart rate, VAS, and operative time during monitored anesthesia were significantly lower than local anesthesia. Compared with general anesthesia, monitored anesthesia led to less adverse anesthetic effects. Monitored anesthesia had the highest perioperative satisfaction and the lowest VAS 2 h postoperatively; however, the monitored anesthesia group had the lowest MAP and heart rate 2 h postoperatively. Based on better sedation and analgesia, monitored anesthesia with dexmedetomidine achieved better patient cooperation, a shorter operative time, and lower adverse events during PKP; however, the MAP and heart rate in the monitored anesthesia group should be closely observed after surgery.

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Safe and Efficacious Use of Dexmedetomidine over a Prolonged Duration for Anxiolysis and as an Adjunct to Analgesia during End-of-Life Care

Cited by 6 publications

References 5 publications

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Dexmedetomidine: a magic bullet on its way into palliative care—a narrative review and practice recommendations

Efeitos do uso de dexmedetomidina na sedação paliativa de pacientes em fim de vida: revisão sistemática

Comparison of different anesthesia modalities during percutaneous kyphoplasty of osteoporotic vertebral compression fractures

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