| Dexmedetomidine | Esmolol |
---|---|---|
Characteristics | Highly selective alpha-2 adrenoreceptor agonist | Short-acting, selective beta-1 blocker |
Mode of action | Acts centrally, predominantly in the brain stem (sedation) and in the spinal cord (analgesia) | Acts peripherally, predominantly in the heart |
Effects | Short- and long-term sedation in the intensive care unit setting | Negative chronotropic, dromotropic, inotropic effects |
Improves ventricular filling by prolonging diastole | ||
Anxiolysis; opioid-sparing effect; anti-delirant effects | Sympatholytic activity | |
Sympatholytic activity | ||
Route of administration; dose | Intravenous infusion: 0.2–1.4 μg/kg/h Loading dose not recommended in clinical practice | Infusion: 25 mg/h, up-titration every 20 min in increments of 50 mg/h, to reach the target heart rate of <95beats/min |
Pharmacokinetics | Half-life: 1.5Â h | Half-life: 9Â min |
Degradation by hepatic metabolism | Degradation by unspecific esterases | |
No dose adjustments in renal dysfunction | No dose adjustment in renal and/or hepatic dysfunction | |
Adverse haemodynamic effects | Hypotension: 25Â %, serious 1.7Â % | Symptomatic hypotension: 12Â % |
Hypertension: 15Â % | Haemodynamic deterioration in patients with compensatory tachycardia | |
Bradycardia: 13Â %, serious 0.9Â % |