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Dexmedetomidine and the Critically Ill
- Dexmedetomidine is a newer sedative agent that is being used with increasing frequency in the critically ill
- A few pieces of information regarding dexmedetomidine:
- highly selective alpha-2 agonist
- produces dose-dependent sedation and anxiolysis while maintaining arousability at deep levels of sedation (hypercapnic arousal is preserved)
- onset of action is approximately 15 minutes with peak concentration achieved in about 1 hour
- metabolized via the liver
- no known active or toxic metabolites
- loading dose of 1 mcg/kg over 10 minutes followed by 0.2 - 0.7 mcg/kg/hr
- Primary side effect is bradycardia at excessive doses
- Cost is an issue when compared to propofol and midazolam
References
Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.