Dexmedetomidine for short-term and long-term sedation: amplifying its applicability

Background

The α₂-agonist dexmedetomidine (DEX) it is an effective agent for the management of sedation and analgesia after cardiac, general, orthopedic, head and neck, oncologic and vascular surgery in the ICU. DEX is currently approved as a sedative for up to 24 hours use in the ICU, but the number of reports showing safe long-term therapy with very good tolerability is increasing. The α₂-agonists may also attenuate hypertension, anxiety, agitation, tachycardia and fever during benzodiazepine and opioid withdrawal [1].

Objective

To describe the experience with DEX in the surgical ICU, for early postoperative and long-term sedation of critically ill patients and for withdrawal syndrome management.

Design and setting

A retrospective review of medical records and presentation of case-series (n = 13) from a surgical ICU (14 beds) of a university hospital from August 2004 to February 2005.

Results

The 13 critically ill patients (eight male, five female; age 41–83 years) who received DEX were elective or complicated postoperative patients who required sedation and mechanical ventilation in the ICU for a variety of medical problems. We have included one case of withdrawal syndrome after interruption of prolonged midazolam and fentanyl infusion, and two cases of bariatric surgery (rarely reported in literature). The patients received DEX infusion during at least 6 hours. The mean time of drug administration was 45 hours (6–336 hours). Only mild falls in arterial pressure occurred in some patients, but in none of them was DEX discontinued (managed with fluid challenge or a slight increase in vasoactive drug). Only three patients required a single dose of fentanyl (100 μg) as rescue analgesia.

Conclusion

DEX is an effective and safe sedative agent that has analgesic properties and predictable cardiovascular effects, and may benefit a heterogeneous population of critically ill patients for short-term (early postoperative period) and long-term sedation. We believe that a continuous infusion of a α₂-agonist agent for sedation-induced withdrawal syndrome management is highly applicable.