Is Dexmedetomedine the Jack of all perioperative trades?

Abstract

Since it was first approved by the Food and Drug Administration in 1999 and in 2011 by the European Union, dexmedetomidine (DEX) has gained widespread use first in adults and later paediatric patients undergoing cardiac surgery. And considering this α2-adrenoceptor agonist’s side-effect profile, it is no wonder its perioperative application continues to increase. As an analgosedative that does not depress respiration, DEX’s beneficial properties extend from anaesthetic- and analgetic-sparing effects [1] enabling early extubation to delirium prophylaxis and overall faster recovery after surgery. Administering DEX is believed to reduce adverse neurocognitive outcomes in adults undergoing cardiovascular surgery [2]. Consistent with those findings, a recent meta-analysis on paediatric congenital heart surgery [3] reported reduced levels of S-100β and NSE, markers for postoperative cognitive function. In this issue, Bourgoin et al. [4] describe the efficacy of intraoperative high-dose DEX, administration that resulted in an 8.8% reduction in postoperative tachyarrhythmias in neonates and infants undergoing congenital heart surgery. They also confirmed a sparing effect for other analgesics, and a tendency towards shorter intubation time.