Dexmedetomidine

Abstract

Objective. To provide a general descriptive account and review of the literature regarding the use of dexmedetomidine for sedation during fiberoptic bronchscopic (FOB) intubation. Data Source. A computerized bibliographic search of the literature regarding dexmedetomidine for FOB intubation. Main Results. Several anecdotal reports describe the use of dexmedetomidine to provide sedation during FOB intubation. Additionally, 7 prospective trials were identified. These prospective trials demonstrate the efficacy of dexmedetomidine in providing sedation during FOB intubation of the airway. In a placebo-controlled trial with midazolam used as the rescue medication, dexmedetomidine decreased the need for rescue midazolam and the combination of the 2 agents was better than midazolam alone. When compared with propofol, there were fewer airway and respiratory issues as well as improved patient comfort with dexmedetomidine. Although dexmedetomidine was found to be better than fentanyl, there was a higher incidence of adverse hemodynamic effects. Although dexmedetomidine was inferior to remifentanil, the study used a lower loading dose of dexmedetomidine than other studies (0.4 vs 1.0 µg/kg). Despite its efficacy, adverse hemodynamic effects were noted. In many cases, the incidence was higher with dexmedetomidine than the comparator agent. In all reported cases, these were corrected with the administration of atropine, a vasoactive medication (phenylephrine or ephedrine), and/or fluid. Conclusions. The present literature clearly reports the advantage of using dexmedetomidine to decrease the risk of adverse respiratory effects, including airway obstruction. However, there remain unanswered questions about dexmedetomidine for sedation during FOB intubation of the airway including dosing regimens for both the bolus and infusion, techniques to limit the potential for adverse hemodynamic effects, and whether it should be the sole agent or used in combination with another agent.