Clinical Application Of Dexmedetomidine Research Articles

Clinical application of dexmedetomidine combined with dezocine in local anesthesia for endoscopic dacryocystorhinostomy.

To investigate the clinical effect of dexmedetomidine combined with dezocine in local anesthesia for endoscopic dacryocystorhinostomy (DCR). Ninety patients undergoing elective endoscopic DCR were randomly divided into two groups, local anesthesia group (LA group n = 45) and general anesthesia group (GA group, n = 45). These subjects were all American Society of Anesthesiologists (ASA)-Physical Status I-II patients. The changes of mean arterial pressure (MAP) and heart rate (HR) were observed and recorded before anesthesia (T0), after anesthesia (T1), at the beginning of surgery (T2), and at the end of surgery (T3). The visual analogue scale (VAS) score was observed and recorded immediately after awakening from anesthesia and at 1, 2, 6, and 12h after surgery. Additionally, the occurrence of adverse reactions after surgery and the sedation-agitation scale (SAS) score after awakening were recorded. Compared with the LA group, the MAP and HR of the GA group were significantly lower at T1 and T2, but significantly higher at T3. Local anesthesia was associated with lower VAS score immediately after awakening and at 1, 2, 6, and 12h after surgery. Also, local anesthesia caused a lower incidence of postoperative agitation, nausea, and vomiting. The SAS score in the LA group was markedly higher than that in the GA group. Local anesthesia with dexmedetomidine and dezocine as adjuvants in endoscopic DCR has more stable hemodynamics and reduces the stress response during perioperative period. Also, this anesthesia achieves better postoperative sedation and analgesia effects, reduces postoperative complications, and improves the quality of awakening from anesthesia. Collectively, local anesthesia is a comfortable and safe option for patients with high risks of general anesthesia and those unwilling to receive general anesthesia.

Cardiac Protection Mechanism and Clinical Application of Dexmedetomidine

Dexmedetomidine is an α2 adrenoceptor agonist and has cardioprotective effect,the mechanism of which is being studied.Increasing studies have proved the clinical value of dexmedetomidine in reducing postoperative complications and improving the prognosis of patients.Therefore,this review summarizes the cardiac protection mechanism of dexmedetomidine based on the existing studies and expounds the application of dexmedetomidine in the perioperative period of cardiovascular surgery.

Recent Advances in the Clinical Value and Potential of Dexmedetomidine.

Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

Systemic effects and clinical application of dexmedetomidine

Dexmedetomidine is a most potent α-2 adrenergic selective agonist. It is one of the components of the racemic mixture of two enantiomers of medetomidine. It has a selectivity ratio of 1620/1(α 2/ α1), which is 5–10 times higher than that for detomidine (260/1) and xylazine (160/1. Dexmedetomidine produces consistent sedation, anxiolysis and muscle relaxation, which makes it a popular sedative agent in veterinary medicine. In veterinary practice, it is used for premedication and as an adjunct to general anaesthesia in several species. Similar to other alpha-2 agonists it exerts its effect through the action on alpha-2 adrenergic receptors. The sedative and anxiolytic effects of α-2 agonists are mediated by agonism of supraspinal autoreceptors situated in the pons, whereas analgesic effects are mediated by agonism of heteroreceptors located in the dorsal horn of the spinal cord. Dexmedetomidine causes a dose-dependent redistribution of blood flow and preserves blood flow to the most vital organs at the expense of organs like skin and pancreases and this distribution of blood flow is not affected by the type of anaesthesia. The pattern of cardiovascular changes may be affected by the dose used and the type of anaesthetic combined with dexmedetomidine. Most anaesthetic drugs, such as propofol, thiopental, isoflurane and halothane have cardiovascular and respiratory side effects that are dose-dependent. Dexmedetomidine is a good anaesthetic adjuvant for general anaesthesia which reduces intra-operative isoflurane consumption provides analgesic-sparing effect without affecting postoperative recovery profile and improved cardiovascular stability and contributes to the provision of balanced anaesthesia.

Dexmedetomidine promotes the progression of hepatocellular carcinoma through hepatic stellate cell activation

Dexmedetomidine (DEX) is an anesthetic that is widely used in the clinic, and it has been reported to exhibit paradoxical effects in the progression of multiple solid tumors. In this study, we sought to explore the mechanism by which DEX regulates hepatocellular carcinoma (HCC) progression underlying liver fibrosis. We determined the effects of DEX on tumor progression in an orthotopic HCC mouse model of fibrotic liver. A coculture system and a subcutaneous xenograft model involving coimplantation of mouse hepatoma cells (H22) and primary activated hepatic stellate cells (aHSCs) were used to study the effects of DEX on HCC progression. We found that in the preclinical mouse model of liver fibrosis, DEX treatment significantly shortened median survival time and promoted tumor growth, intrahepatic metastasis and pulmonary metastasis. The DEX receptor (ADRA2A) was mainly expressed in aHSCs but was barely detected in HCC cells. DEX dramatically reinforced HCC malignant behaviors in the presence of aHSCs in both the coculture system and the coimplantation mouse model, but DEX alone exerted no significant effects on the malignancy of HCC. Mechanistically, DEX induced IL-6 secretion from aHSCs and promoted HCC progression via STAT3 activation. Our findings provide evidence that the clinical application of DEX may cause undesirable side effects in HCC patients with liver fibrosis.

右美托咪定滴鼻在老年无痛胃肠镜舒适化医疗中的临床应用

右美托咪定滴鼻在老年无痛胃肠镜舒适化医疗中的临床应用

Effects of dexmedetomidine on perioperative brain protection in patients undergoing craniocerebral surgery under inhalation anesthesia with sevoflurane: a randomized controlled study

Background and objective: The inhalational anesthetic sevoflurane is often used in craniocerebral surgery for its advantages of quick onset, stable circulation, high safety, and few adverse reactions. However, it can also lead to abnormal blood pressure and heart rate, as well as restlessness and pain. Therefore, an auxiliary anesthetic is needed to help reduce adverse reactions. Dexmedetomidine is a potent and highly selective α2 adrenergic receptor agonist that has anti-anxiety, hypnotic, analgesic, sedative, and sympatholytic properties. Dexmedetomidine has been shown to reduce restlessness after sevoflurane inhalation anesthesia and minimize perioperative hemodynamic fluctuation. However, its application in craniocerebral surgery should be validated. The purpose of this study was to investigate the efficacy of dexmedetomidine in craniocerebral surgery under sevoflurane inhalation anesthesia. Subjects and methods: The prospective, single-center, randomized, controlled study will be performed in Taihe Hospital (Shiyan, China). The 1308 patients to be included in this study will be randomly divided into a trial group and control group (n = 654 patients per group) based on a table of random permutations. In both groups, sevoflurane will be used for induction of anesthesia for craniocerebral surgery. In the trial group, 1 μg/kg dexmedetomidine will be injected intravenously for 10 minutes commencing 15 minutes before anesthesia induction, and then continuously pumped at 0.3 μg/kg per hour until 30 minutes before surgery. In the control group, 0.9% sodium chloride injection will be administered in the same way and at the same injection rate. This trial was approved by the Ethics Review Committee of Taihe Hospital on December 8, 2015 (approval No. 2015GJJ-087). Protocol version: 1.0. Participants will not be blind to the study protocol or procedure, and will provide signed informed consent. Results: The primary outcome of this study is recovery time. Secondary outcomes of this study include anesthesia, recovery, and adverse events, as well as vital signs, stress index, and cerebral metabolic rate of oxygen consumption at different time points (before and after administration of the loading dose of dexmedetomidine, during anesthesia induction, at the beginning of craniocerebral surgery, during craniocerebral surgery, at the end of craniocerebral surgery, and at the time of recovery). A pilot study involving 190 patients who underwent craniocerebral surgery was performed between March 2016 and February 2017. These 190 patients randomly received either sevoflurane anesthesia (n = 95, control group) or dexmedetomidine and sevoflurane anesthesia (n = 95, trial group). Results of the pilot group showed that anesthesia time, intraoperative bleeding volume, intraoperative infusion volume, recovery time, and extubation time were similar between trial and control groups (P > 0.05). However, compared with the control group, the administered dosages of vasoactive drugs ephedrine and esmolol were significantly lower (P Conclusion: Findings from this study will help determine whether dexmedetomidine can reduce hemodynamic fluctuation, lower stress index, and protect the brain in patients who undergo craniocerebral surgery under inhalation anesthesia with sevoflurane. The results can provide evidence to support clinical application of dexmedetomidine combined with sevoflurane for craniocerebral surgery. Trial registration: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2000030459).

The clinical application of dexmedetomidine in neonates

Dexmedetomidine exerts sedative, analgesic and anti-sympathetic effects mainly through activating α2-adrenergic receptors in the presynaptic and posterior membranes.It has little influence on respiratory system as well as hematological dynamics.In addition, it can be administered by nasal instillation with fast effect, minor trauma and proper duration of action.In recent years, it has been gradually used in neonatal anesthesia assistance, sedation and analgesia of mechanical ventilation, auxiliary examination, etc.This article reviews the progress in clinical application of dexmedetomidine in neonates. Key words: Dexmedetomidine; Sedation; Analgesia; Newborn

Tardive dyskinesia and dexmedetomidine

SummaryA 52‐year‐old female patient presented for a caudal epidurogram and epidural steroid injection. Patient compliance was limited by severe tardive dyskinesia secondary to previous chlorpromazine treatment. Based on a report of effectiveness in propofol‐induced dyskinesias, an infusion of dexmedetomidine was used which effectively controlled the movements within a few minutes. The patient remained alert and comfortable throughout. This report highlights the pharmacology and clinical application of dexmedetomidine in this clinical scenario, and proposes potential mechanisms underlying this therapeutic effect.

Progresses of dexmedetomidine for pediatric clinical anesthesia

Dexmedetomidine, a highly effective and selective adrenergic α2 receptor agonist, is applied in the sedation of adult ICU, and it is widely used in clinical anesthesia in recent years.Dexmedetomidine is still in the exploratory stage in clinical application of children.However, there are more evidence suggesting that dexmedetomidine has presented good effects in the anxiolytic, pediatric sedation, analgesic, anti-sympathetic, and stablizing hemodynamic.This review presents the clinical application of dexmedetomidine in pediatric clinical anesthesia. Key words: Dexmedetomidine; Anesthesia; Children

Development and clinical use of dexmedetomidine in neurosurgical procedures

Background Dexmedetomidine (DEX) is a potent and highly selective α-2 adrenoreceptor agonist,it provides dose-dependent sedation,analgesia,anxiolysis and sympatholysis.It doesn't increase intracranial pressure and can provide good pereoperative homodynamic stability with decreased intraoperative anesthetics requirements,especial the opiates.In addition,DEX has displayed potential neuroprotective properties.Purpose The aim of this review was to outline the advances of the use of DEX and provide practical guidance in neurosurgery clinical anesthesia.Content From the aspects of mechanism of action and clinical application,we reviewed the pharmacological characteristics and neuroprotective effects of DEX.Trend As a new anesthetic adjuvant,the clinical application of DEX in neurosurgery anesthesia is quite promising. Key words: Dexmedetomidine; Neurosurgery; Anesthesia; Neuroprotection

Advance in clinical application of dexmedetomidine in pediatric patients

Background As a new α2-adrenoceptor agonist,dexmedetomidine plays key roles in sedation,analgesia as well as inhibition of sympathetic.Since it has advantages of fast effect and rapid clearance,and has no effect on the repiratory,it's widely used in pediatrics at home and abroad.Objective To understand the application of dexmedetomidine in pediatrics and provide the reference for clinical use.Content This article summarizes the pharmacokinetics of dexmedetomidine in children and its impacts on respiration and circulation,and in particularly discusses its applications in common clinical fields in pediatric such as painless pediatric imaging services,pediatric anesthesia as well as pediatric Intensive Care Unit (PICU).Trend Dexmedetomidine has unique advantages not only in the sedation for non -invasive examinations but also in the prevention and treatment of postoperative delirium. Key words: Dexmedetomidine; Pediatric patients

Clinical observation on dexmedetomidine on the patients with endotracheal tube after brain stem surgery

Objective To investigate the clinical application of dexmedetomidine on the patients with endotracheal tube after brain surgery.Methods 40 patients undergoing elective surgery for excision of brain stem tumor under general anesthesia were enrolled and randomly divided into 2 groups,dexmedetomidine group (group D,n=20) and midazolam group (group M,n=20).Dexmedetomidine 0.3-0.5 μ g·kg-1 ·h-1was administered for 24 hours to the patients in group D,while midazolam 0.05 mg·kg-1·h-1 was administered for 24 hours to the patients in group M.The tolerance to the endotracheal tube,the parameters of hemodynamics and respiration were recorded.Results All patients in group D tolerated to the endotracheal tube very well.The hemodynamic parameters and the parameters of respirstion in group D were stable.In group M,5 patients could not tolerate to the endotracheal tube,5 patients tolerated to the endotracheal tube not very well and 10 ones did well.Mild respiratory depression was recorded in group M,and the parameters of hemodynamics in group M fluctuated obviously.Conclusion The patients with endotracheal tube after surgery administered with dexmedetomidine tolerate to the endotracheal tube very well,the hemodynamic and respiratory parameters are stable. Key words: Tolerance to the endotracheal tube; Dexmedetomidine; Midazolam

The clinical application of dexmedetomidine in the perioperative period of cardiac surgery

Background Dexmedetomidine (DEX),a highly potent selective alpha-2 adrenergic agonist,has not only sedative,analgesic and anxiolytic effects,but also anti-sympathetic and autorhythmicity-blockade properties which might be beneficial to high-risk cardiac situations.Therefore,its application has been increasing in the perioperative period of cardiac surgery.Objective To assess the efficacy and safety of DEX application in the perioperative period of cardiac surgery and provide evidence for its clinical application.Content This review introduced the pharmacological properties of DEX on cardiovascular system,and summarized the specific proposal and safety of DEX when used in different periods of cardiac surgery.Trend DEX has been proved to possess the unique advantages through the application in the perioperative period of cardiac surgery,and will be widely used in the future. Key words: Dexmedetomidine; Cardiac surgery; Perioperative period

Advances of the clinical application of dexmedetomidine in anesthesia

Background Dexmedetomidine, a potent and highly selective alpha2-adrenoreceptor agonist, acts with sedative,analgesic and anxiolytic properties. Since it was approved for sedation in intensive care unit (ICU) by the Food and Drug Administration of US in 1999, it has been increasingly used in clinical anesthesia. Purpose The aim of this review was to outline the advances of its use in clinical anesthesia and provide practical guidance for clinical anesthetists. Content From the aspects of mechanism of action and clinical application, we reviewed different properties of sedation, analgesia, inhibition of intraoperative stress response, aid in anesthesia and influence on postoperative recovery of dexmedetomidine. Trend As a new anesthetic adjuvant, the clinical application of dexmedetomidine in anesthesia is quite promising. Key words: Dexmedetomidine; Alpha2-adrenoreceptor agonist; Clinical anesthesia

Clinical application of dexmedetomidine

Dexmedetomidine is a highly selective and potent alpha2-adrenoreceptor (AR) agonist offering dosedependent sedation, anxiolysis and analgesia. It is a relatively new drug, approved for sedation for up to 24 hours in mechanically ventilated post-cardiac surgery patients. Yet, because of its unique drug profile, it has been increasingly studied and used in various clinical settings, albeit off label, with promising results. The purpose of this review is to discuss dexmedetomidine in terms of its pharmacokinetics and pharmacodynamics, and to focus on its various clinical applications. A PubMed search, using the keyword “dexmedetomidine”, identified approximately 1,000 articles, the earliest being animal studies published in 1988.