Anesth Pain Med.  2017 Oct;12(4):306-319. 10.17085/apm.2017.12.4.306.

Current clinical application of dexmedetomidine for sedation and anesthesia

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea. kds0728md@gmail.com
  • 2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
  • 3Department of Anesthesiology and Pain Medicine, Daegu Fatima Hospital, Daegu, Korea.
  • 4Department of Anesthesiology and Pain Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 5Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 6Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
  • 7Department of Anesthesiology and Pain Medicine, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea.
  • 8Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

Many sedatives are used clinically and include benzodiazepines, barbiturates, antihistamines, propofol, and alpha-2-agonist. Benzodiazepines activate GABA neuronal receptors in the brain and present sedating, hypnotic, anxiolytic, amnestic, and anticonvulsant effects, but low analgesic effects. Propofol induce sedative, anxiolytic, and amnestic effects but no analgesic effects. However, risks such as cardiopulmonary instability and hypotension must be considered during administration. Dexmedetomidine is a high selective alpha-2 agonist and has many advantages as a sedative. Patients under dexmedetomidine sedation awaken easily and are more likely to be cooperative. Risk of respiratory depression and cardiopulmonary instability is low as well. Additionally, dexmedetomidine decreases amount of analgesic needed during and after surgery, presenting analgesic effects. Dexmedetomidine also decreases risk of delirium. However, bradycardia may occur and biphasic effects on blood pressure may be observed during beginning of administration. Because of lengthy symptom onset and offset time, physicians should carefully control administration at the beginning and end of dexmedetomidine administration. The purpose of this review is to evaluate the efficacy and availability of dexmedetomidine in various clinical fields including sedation for critically ill patients, regional anesthesia, monitored anesthesia care for some invasive procedures, stabilization of heart in cardiac surgery or endoscopic procedures.

Keyword

Dexmedetomidine; Procedure; Regional anesthesia; Sedation

MeSH Terms

Anesthesia*
Anesthesia, Conduction
Barbiturates
Benzodiazepines
Blood Pressure
Bradycardia
Brain
Critical Illness
Delirium
Dexmedetomidine*
GABAergic Neurons
Heart
Histamine Antagonists
Humans
Hypnotics and Sedatives
Hypotension
Propofol
Respiratory Insufficiency
Thoracic Surgery
Barbiturates
Benzodiazepines
Dexmedetomidine
Histamine Antagonists
Hypnotics and Sedatives
Propofol

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