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Dexmedetomidine, almost as many uses as there are letters

Dexmedetomidine (Dex) is an alpha 2-adrenergic agonist which causes sedation, amnesia, and mild anesthetic properties. Uniquely, it causes deep sedation with maintained arousability without the dreaded side effect of respiratory depression. This medication has found its way into multiple applications in the ED setting from pediatric procedures to helping facilitate much needed imaging. Its sedative properties have even found a role in adults receiving non-invasive ventilation and even in our most critically ill patients on mechanical ventilation.

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 Dexmedetomidine in the ED

In the pediatric setting, dexmedetomidine has been garnering popularity as an alternative to propofol among nonanesthesiologists for sedation of children during diagnostic CT and MRI imaging. Comparative studies have seen an association between using higher doses of dexmedetomidine and higher rates of completion of imaging without the need to administer another sedative. One study found that utilizing higher doses of dexmedetomidine even resulted in shorter recovery times, which the authors attributed to the lower use of barbiturates for rescue sedation.

Articles of Interest

Dexmedetomidine for Sedation in Pediatric ED

Dexmedetomidine makes them sleepy, but rousable! Which may be just what you want! Combination of Dexmedetomidine and Ketamine has been shown to be effective and safe with shorter onset and recovery times.

Dexmedetomidine: a novel sedative-analgesic agent

Since the first report of clonidine, an α2-adrenoceptor agonist, the indications for this class of drugs have continued to expand. In December 1999, dexmedetomidine was approved as the most recent agent in this group and was introduced into clinical practice as a short-term sedative.

Dexmedetomidine: A Review of Its Use for Sedation in the Intensive Care Setting

Dexmedetomidine (Dexdor®) is a highly selective α2-adrenoceptor agonist. It has sedative, analgesic and opioid-sparing effects and is suitable for short- and longer-term sedation in an intensive care setting.

Procedural Sedation With Dexmedetomidine in Combination With Ketamine in the Emergency Department

Dexmedetomidine is an alternative agent for procedural sedation in the emergency department thanks to its ability to maintain hemodynamic and respiratory stability. Dexmedetomidine must, however, be combined with a powerful analgesic

ToxCard: Dexmedetomidine & Ketamine in Toxicologic Causes of Agitation

Dexmedetomidine is a highly selective alpha-2 adrenoreceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic properties [1]. Sedative effects are secondary to the alpha-2 agonism in the locus coeruleus, whereas the analgesic effects stem from alpha-2 receptors in the central nervous system and spinal cord. It was originally approved for less than 24-hour sedation of mechanically ventilated patients in the ICU and then subsequently for sedation of non-intubated patients prior to and/or during procedures. However, off-label uses continue to expand given its advantageous properties.

“Don’t Set the Precedent”: Precedex for Alcohol Withdrawal

Precedex is a cool drug. It’s a continuous IV medication that causes anesthetic and sedative effects through agonizing alpha-2 adrenergic receptors in the brainstem, inhibiting norepinephrine release. The bummer is that it can cause bradycardia through its effects on presynaptic alpha-2-adrenergic receptors and hypotension through peripheral vasodilation. The nice thing about Precedex is that it can reduce autonomic symptoms while still allowing the patient to be arousable and cooperative without causing respiratory depression. But a very important thing to remember here is that Precedex should never be used alone in alcohol withdrawal. It’s mechanism of action doesn’t affect GABA or NMDA receptors at all- so it doesn’t treat the underlying pathophysiology of the disorder.

Resources

Dexmedetomidine

selective alpha 2 agonist in CNS, 8 times more selective than clonidine), binds all 3 subtypes of alpha2 receptor (A, B, C)