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Abstract

Introduction: Dexmedetomidine is an alpha-2 receptor agonist indicated for intensive care unit and procedural sedation. In addition to its sedative properties, dexmedetomidine has sympatholytic effects that reduce heart rate and blood pressure. Alcohol withdrawal is characterized by agitation, psychosis, and manifestations of autonomic hyperactivity. The objective of this study was to evaluate the use of adjunctive dexmedetomidine for severe alcohol withdrawal. Hypothesis: Addition of dexmedetomidine results in reduced benzodiazepine use, withdrawal symptoms, and causes minimal side effects. Methods: This retrospective study evaluated patients >18 years old with severe alcohol withdrawal treated with dexmedetomidine in conjunction with the standard of care. Patients without a Clinical Institute Withdrawal Assessment (CIWA) score of?8 or those prescribed dexmedetomidine for other indications were excluded. Patient vital signs, CIWA scores, benzodiazepine use, and dexmedetomidine doses and duration were compared pre- and post-dexmedetomidine initiation. Paired t-tests were utilized to compare continuous variables, with p<0.05 considered significant. Results: Sixteen patients were enrolled. The majority of patients were male (94%) with an average age of 44.3 ± 13.6 years. The mean APACHE II score was 16.1 ± 8.2, and mean length of stay in the ICU was 131.8 ± 65.9 hours. Average duration of dexmedetomidine was 40.4 ± 39.2 hours at a mean dose of 0.52 ± 0.23 mcg/kg/hour started 41.7 ± 20.2 hours after admission. Total benzodiazepine exposure, represented by milligrams of lorazepam equivalents, was less after initiating dexmedetomidine (39.4 ± 28 vs 18.2 ± 18; p=0.018), as was the average CIWA score (14.5 ± 4.2 vs 9.0 ± 4.6; p=0.004). Heart rate (106.8 ± 15.9 vs 82.7 ± 12.4; p=0.0001) and systolic blood pressure (135.8 ± 15.2 vs 124.6 ± 20.6; p=0.035) were reduced with the addition of dexmedetomidine. Bradycardia (HR?60) or hypotension (SBP?90) each occurred in 25% of patients and both occurred in 6% of patients. Conclusions: The addition of dexmedetomidine blunts the symptoms of autonomic hyperactivity and reduces benzodiazepine requirements; however, these beneficial effects must be weighed against the risk of bradycardia and hypotension.