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Table 2 Pharmacological properties of the study drugs

From: Decatecholaminisation during sepsis

 

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: 1.5 h

Half-life: 9 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: 25 %, serious 1.7 %

Symptomatic hypotension: 12 %

Hypertension: 15 %

Haemodynamic deterioration in patients with compensatory tachycardia

Bradycardia: 13 %, serious 0.9 %