Utility Of Dexmedetomidine Research Articles

Utility of Dexmedetomidine in Paediatric Cardiac Surgery: a Systematic Review and Meta-analysis

Dexmedetomidine is a selector α 2-agonist that provides sedation with sparing respiratory depression, anxiolysis, and analgesic adjunct with opioids and benzodiazepines sparing effects, prolongs the duration of regional anesthesia and allows early tracheal extubation after pediatric cardiac surgery.[1,2,3 ] Recently, dexmedetomidine has been established as a cardioprotective agent in adult cardiac surgical patients. Some trials show significantly lower myocardial injury markers like interleukin-6 (IL-6) levels, cardiac troponin I (cTnI), and creatinine kinase-myocardial band (CK-MB), after cardiac surgery in the dexmedetomidine group.[ ] The majority of published studies have suggested that dexmedetomidine is a seemingly efficacious agent protecting against cardiac injury during CPB.[6] Its administration lowers mechanical ventilation period, ICU stay, and length of hospital stay after pediatric cardiac surgery. In addition, it is effective against postoperative shivering, refractory JET rhythm and Tet spells, and acute kidney injury (AKI) in cyanotic pediatric patients undergoing corrective surgery. However, studies on its application in pediatric heart surgery using cardiopulmonary bypass (CPB) remain limited. This systematic review aimed to provide information on the utility of dexmedetomidine in patients undergoing pediatric cardiac surgery using CPB: hemodynamic stability, cardioprotective, renal protection, neuroprotective effects, control of refractory JET, and Tet spells, and the early and late outcome.

Utility of dexmedetomidine on surgical site wound pain undergoing thoracoscopic surgery: A meta-analysis.

We conducted this study aimed to evaluate the analgesic effect of dexmedetomidine in thoracoscopic surgery on postoperative wound pain, and to provide a reference for clinical use of the drug. We searched PubMed, Embase, Cochrane Library, Web of Science, Wanfang, Chinese Biomedical Literature Database and China National Knowledge Infrastructure databases, and supplemented with manual searching. We searched from database inception to October 2023, to collect the randomised controlled trials (RCTs) on dexmedetomidine application in thoracoscopic surgery. Two researchers screened all the literature according to the inclusion and exclusion criteria and the literature included in the study was evaluated for quality, extracted information and required data. Stata 17.0 software was employed for data analysis and the outcomes were 2 6, 12, 24 and 48 h postoperative wound visual analog scores (VAS). Twenty-four RCTs totalling 2246 patients undergoing thoracoscopic surgery were finally included. The analysis revealed dexmedetomidine applied to thoracoscopic surgery significantly reduced the postoperative wound VAS scores at 2 h (SMD: -0.96, 95% CI: -1.57 to -0.36, p = 0.002), 6 h (SMD: -0.98, 95% CI: -1.27 to -0.69, p < 0.001), 12 h (SMD: -1.19, 95% CI: -1.44 to -0.94, p < 0.001), 24 h (SMD: -0.91, 95% CI: -1.16 to -0.66, p < 0.001) and 48 h (SMD: -0.75, 95% CI: -1.02 to -0.48, p < 0.001). Our results suggest dexmedetomidine applied to thoracoscopic surgery can significantly reduce postoperative wound pain, which is worthy of clinical application.

Dexmedetomidine Infusion as a Novel Supportive Therapy for Fluphenazine-Induced Neuroleptic Malignant Syndrome in a 10-Year-Old Boy: A Case Report and Review of Literature

AbstractA 10-year-old male child patient developed symptoms of neuroleptic malignant syndrome (NMS) 1 month following initiation of fluphenazine for behavioral therapeutic management. Dexmedetomidine infusion was able to adequately control the symptoms of NMS with resolution of encephalopathy. This was the first report of novel dexmedetomidine utilization for the treatment of NMS. We suggest using dexmedetomidine as an adjunctive agent to control NMS symptomatology without attendant risk of respiratory depression.

Tu1003 Utility of Dexmedetomidine for Esophageal Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Tu1003 Utility of Dexmedetomidine for Esophageal Endoscopic Submucosal Dissection: A Prospective Randomized Controlled Trial

Utility of Dexmedetomidine in Sedation for Radiofrequency Ablation of Atrial Fibrillation

I read with great interest the article recently published in the Journal of PeriAnesthesia Nursing that examined the utility of using dexmedetomidine (DEX) as an adjunct to midazolam and fentanyl for procedural sedation and analgesia during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF).1 With the view toward advancing knowledge about more effective medications for sedation in this challenging context, I offer the following insights for readers to consider regarding this study.

Utility of Dexmedetomidine in Sedation for Radiofrequency Ablation of Atrial Fibrillation

The utility of dexmedetomidine (DEX) as an adjunct to conventional procedural sedation using midazolam and fentanyl was evaluated in 11 adult patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation. In a subsequent comparison to 11 demographically matched controls (n=22) that previously received only midazolam- and fentanyl-based sedation, no significant differences in consumption of midazolam (median, 5 vs 10 mg; P=.3), fentanyl (median, 275 vs 400 mcg, P=.2), respiratory parameters, and procedural outcome were found. However, median reductions of arterial blood pressure were significant: systolic (-26.1 vs -16.7 mm Hg, P=.006), diastolic (-26.7 vs -2.9 mm Hg, P=.01), and mean (-25.8 vs -8.5 mm Hg, P=.006). Reductions of blood pressure limited utility of DEX as adjunct in sedation for RFCA of atrial fibrillation.

Reply: Utility of Dexmedetomidine in Sedation for Radiofrequency Ablation of Atrial Fibrillation

The utility of dexmedetomidine (DEX) as an adjunct to conventional procedural sedation using midazolam and fentanyl was evaluated in 11 adult patients undergoing radiofrequency catheter ablation (RFCA) of atrial fibrillation. In a subsequent comparison to 11 demographically matched controls (n = 22) that previously received only midazolam- and fentanyl-based sedation, no significant differences in consumption of midazolam (median, 5 vs 10 mg; P = .3), fentanyl (median, 275 vs 400 mcg, P = .2), respiratory parameters, and procedural outcome were found. However, median reductions of arterial blood pressure were significant: systolic (−26.1 vs −16.7 mm Hg, P = .006), diastolic (−26.7 vs −2.9 mm Hg, P = .01), and mean (−25.8 vs −8.5 mm Hg, P = .006). Reductions of blood pressure limited utility of DEX as adjunct in sedation for RFCA of atrial fibrillation.

Efficacy and safety of intraoperative dexmedetomidine in pediatric posttonsillectomy pain: Peritonsillar versus intravenous administration

BackgroundAlthough being used off-label, the utility of dexmedetomidine in pediatric settings is increasing. Alpha-2 agonists have peripheral analgesic effects. This prospective, randomized, double-blind, Placebo-controlled study was designed to evaluate the safety and efficacy of dexmedetomidine single intraoperative preincisional dose in pediatric patients undergoing tonsillectomy and adenoidectomy.Patients and methodsEighty-four children (5–12 years) were randomized into three groups: DEX.IV (n = 28) received dexmedetomidine 1 μg/kg iv. infusion in 10 min, DEX.PT (n = 28) received dexmedetomidine 1 μg/kg peritonsillar infiltration, and the Placebo controls (n = 28). Assessment parameters included pain, sedation, hemodynamics, and adverse effects.ResultsIntraoperative dexmedetomidine administration resulted in a significant reduction in pain scores postoperatively in the DEX.IV and DEX.PT groups, with no significant difference between them. The time to first postoperative analgesic request was significantly prolonged in DEX.IV (583.45 ± 157.94 min, P < 0.000) and DEX.PT (537.61 ± 106.17 min, P < 0.000) groups compared with the Placebo group (119.75 ± 43.44 min). Similarly, a significantly lower paracetamol consumption during the first postoperative day was recorded in the DEX.IV (459.37 ± 114.82 mg, P < 0.000) and DEX.PT (475.38 ± 143.11 mg, P < 0.000) groups, than in the Placebo group (705.00 ± 249.27 mg), with no significant difference between DEX.IV and DEX.PT groups. Patients in the DEX.IV group exhibited significantly prolonged extubation times ((13.83 ± 3.38 min, P < 0.000) and significantly higher mean Ramsay sedation scores at 15, 30, 60, 120, and 180 min postoperative (P < 0.000), compared with DEX.PT and Placebo groups. The mean intraoperative heart rates were significantly slower in DEX.IV group during and after the intravenous infusion of dexmedetomidine and at 15th min intraoperative (p < 0.05), compared with DEX.PT and Placebo groups, with no significant differences in mean heart rates among the groups in other time points measured. Patients in DEX.PT group had a significantly higher total oral intake in first day postoperative (P < 0.000) and a significantly higher family satisfaction (p < 0.000), compared with DEX.IV and Placebo groups.ConclusionPeritonsillar infiltration or iv. dexmedetomidine similarly enhanced the postoperative analgesia after tonsillectomy in pediatric patients. However, locally applied dexmedetomidine was associated with no systemic effects, higher total oral intake in first day postoperative, and higher family satisfaction.

Dexmedetomidine to Control Agitation and Delirium from Toxic Ingestions in Adolescents

Dexmedetomidine is an α(2)-adrenergic agonist that is approved by the Food and Drug Administration for the provision of short term (less than 24 hours) sedation of adults during mechanical ventilation. Given its beneficial physiologic effects including sedation and anxiolysis, various applications have been reported in the pediatric-aged patient. We report the use of dexmedetomidine to control the agitation and violent behavior which resulted from the ingestion of illicit drugs in 3 adolescents. The utility of dexmedetomidine in these scenarios is discussed and its potential beneficial effects on cardiovascular and respiratory function are reviewed.

Dexmedetomidine Use in General Anaesthesia

Dexmedetomidine is a potent and highly selective alpha(2)-adrenoreceptor agonist currently utilized for continuous infusion for sedation/analgesia in the intensive care unit (ICU). Dexmedetomidine offers remarkable pharmacological properties including sedation, anxiolysis, and analgesia with the unique characteristic to cause no respiratory depression. In addition it posses sympatholytic and antinociceptive effects that allow hemodynamic stability during surgical stimulation. Different from most of clinically used anesthetics, dexmedetomidine brings about not only a sedative-hypnotic effect via an action on a single type of receptors, but also an analgesic effect and an autonomic blockade that is beneficial in cardiac risk situations. Several studies have demonstrated its safety, although bradycardia and hypotension are the most predictable and frequent side effects. Dexmedetomidine has shown to consistently reduce opioids, propofol, and benzodiazepines requirements. In the last years it has emerged as an affective therapeutic drug in a wide range of anesthetic management, promising large benefits in the perioperative use. In particular this review focuses on dexmedetomidine utilization in premedication, general surgery, neurosurgery, cardiac surgery, bariatric surgery, and for procedural sedation and awake fiberoptic intubation. In all these fields dexmedetomidine has demonstrated to be an efficacious and safe adjuvant to other sedative and anesthetic medications.