![]() ![]() Dexmedetomidine induces sedation by decreasing activity of noradrenergic neurons in the locus ceruleus in the brain stem, thereby increasing the downstream activity of inhibitory gamma-aminobutyric acid (GABA) neurons in the ventrolateral preoptic nucleus. Unlike opioids and other sedatives such as propofol, dexmedetomidine is able to achieve its effects without causing respiratory depression. It possesses an α 2:α 1 selectivity ratio of 1620:1, making it eight times more selective for the α 2-receptor than clonidine. Pharmacology Pharmacodynamics ĭexmedetomidine is a highly selective α 2-adrenergic agonist. Similarly, drugs that lower blood pressure and heart rate, such as beta blockers, may also have enhanced effects when co-administered with dexmedetomidine. Interactions ĭexmedetomidine may enhance the effects of other sedatives and anesthetics when co-administered. Thus, adverse effects may be reduced by omitting a loading dose. ![]() These adverse events usually occur briefly after administering a loading dose of the drug. ![]() Toxic doses may cause first-degree or second-degree atrioventricular block. Common side effects include: hypotension, hypertension, with slight decreases in heart rate, arrhythmias, and hypoxia. It has a biphasic effect on blood pressure with lower readings at lower drug concentrations and higher readings at higher concentrations. There are no known contraindication to the use of dexmedetomidine. ![]() In 2022 it was approved by the FDA for the treatment of agitation in schizophrenia and bipolar disorder. It has been successfully used to treat opioid withdrawal symptoms. Dexmedetomidine has also been used as an adjunct to neuroaxial anesthesia for lower limb procedures. Other ĭexmedetomidine may be useful for the treatment of the negative cardiovascular effects of acute amphetamines and cocaine intoxication and overdose. In this application, it has been shown to decrease post-operative delirium, pain, nausea and opioid use. It has also been used as an adjunct infusion during general anesthesia. It can be used for sedation required for awake fibreoptic nasal intubation in patients with a difficult airway. Dexmedetomidine is also used for procedural sedation in children. It can be used as an adjunct with other sedatives like benzodiazepines, opioids, and propofol to enhance sedation and help maintain hemodynamic stability by decreasing the requirement of other sedatives. Procedural sedation ĭexmedetomidine can also be used for procedural sedation such as during colonoscopy. From an economic perspective, dexmedetomidine is associated with lower ICU costs, largely due to a shorter time to extubation. Whether this observation has a beneficial psychological impact is unclear. At the very least, when aggregating many study results together, use of dexmedetomidine appears to be associated with less neurocognitive dysfunction compared to other sedatives. However, this finding is not consistent across multiple studies. Ĭompared with other sedatives, some studies suggest dexmedetomidine may be associated with less delirium. Studies suggest dexmedetomidine for sedation in mechanically ventilated adults may reduce time to extubation and ICU stay. Medical uses Intensive care unit sedation Similar to clonidine, it is a sympatholytic drug that acts as an agonist of α 2-adrenergic receptors in certain parts of the brain. It is also used in humans to treat acute agitation associated with schizophrenia or bipolar I or II disorder. Veterinarians use dexmedetomidine for similar purposes in treating cats, dogs, and horses. Dexmedetomidine, sold under the trade name Precedex among others, is a drug used in humans for sedation. ![]()
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