Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist 1 that has gained prominence in the medical field for its sedative, anxiolytic, and analgesic properties. Initially approved for the sedation of mechanically ventilated patients in intensive care units, the uses of dexmedetomidine have since expanded significantly 1.

Dexmedetomidine is commonly used for sedation in intensive care units, especially for patients on mechanical ventilation. Its unique mechanism of action provides several advantages over traditional sedatives like benzodiazepines and propofol. Dexmedetomidine induces a state of sedation that closely resembles natural sleep, allowing patients to be easily aroused and maintain cooperative communication when necessary. This is beneficial for neurological assessments in critically ill patients. In addition, dexmedetomidine has minimal respiratory depressant effects, making it safer for patients with compromised respiratory function 2–5.

Dexmedetomidine also has uses in the perioperative setting as an adjunct to anesthesia to provide sedation, analgesia, and hemodynamic stability. Its sedative properties reduce the need for other anesthetic agents, potentially lowering the risk of side effects. Dexmedetomidine is also effective in blunting the stress response associated with surgery, leading to more stable intraoperative hemodynamics. Its use in procedures that require moderate sedation, such as colonoscopies and cataract surgeries, improves patient comfort and satisfaction while maintaining safety 6–8. In pain management, it is often administered in combination with opioids to enhance pain relief and reduce opioid requirements, thereby minimizing the risk of opioid-related side effects such as respiratory depression, nausea, and constipation. In postoperative pain management, dexmedetomidine provides effective analgesia, particularly in patients undergoing major surgeries 9,10. It is also increasingly used for sedation in non-intubated patients undergoing various procedures, including dental surgeries, imaging studies, and minor surgical interventions 11,12.

When it comes to addressing the unique challenges posed by pediatric anesthesia and sedation, dexmedetomidine has emerged as a valuable tool. Its sedative and analgesic properties, coupled with a favorable safety profile, make it suitable for various pediatric applications, including procedural sedation, premedication before anesthesia, and postoperative sedation. Dexmedetomidine’s minimal respiratory depressant effects are particularly beneficial for children, who are more susceptible to respiratory complications 13,14.

Dexmedetomidine’s unique pharmacological profile and versatility are suited for various uses in intensive care, perioperative care, pain management, procedural sedation, pediatric anesthesia, and the management of delirium and agitation. The benefits of dexmedetomidine, such as minimal respiratory depression, hemodynamic stability, and the ability to maintain patient cooperation, make it a preferred choice in many clinical settings. As research continues to explore its potential uses and benefits, dexmedetomidine is likely to remain a cornerstone in modern anesthesia and critical care practice.

References

1. Dexmedetomidine: Uses, Interactions, Mechanism of Action | DrugBank Online. Available at: https://go.drugbank.com/drugs/DB00633. (Accessed: 2nd July 2024)
2. Shehabi, Y. et al. Early Sedation with Dexmedetomidine in Critically Ill Patients. N. Engl. J. Med. (2019). doi:10.1056/nejmoa1904710
3. Gerlach, A. T. & Murphy, C. V. Sedation with dexmedetomidine in the intensive care setting. Open Access Emergency Medicine (2011). doi:10.2147/OAEM.S17429
4. Dexmedetomidine – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK513303/. (Accessed: 2nd July 2024)
5. Kaur, M. & Singh, P. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth. Essays Res. (2011). doi:10.4103/0259-1162.94750
6. Perioperative Applications of Dexmedetomidine : WFSA – Resources. Available at: https://resources.wfsahq.org/atotw/perioperative-applications-of-dexmedetomidine-atotw-469/. (Accessed: 2nd July 2024)
7. Naaz, S. & Ozair, E. Dexmedetomidine in current anaesthesia practice- a review. J. Clin. Diagnostic Res. (2014). doi:10.7860/JCDR/2014/9624.4946
8. Scott-Warren, V. L. & Sebastian, J. Dexmedetomidine: its use in intensive care medicine and anaesthesia. BJA Educ. 16, 242–246 (2016).doi: 10.1093/bjaed/mkv047
9. Zhao, Y., He, J., Yu, N., Jia, C. & Wang, S. Mechanisms of Dexmedetomidine in Neuropathic Pain. Frontiers in Neuroscience (2020). doi:10.3389/fnins.2020.00330
10. Tang, C. & Xia, Z. Dexmedetomidine in perioperative acute pain management: A non-opioid adjuvant analgesic. Journal of Pain Research (2017). doi:10.2147/JPR.S139387
11. Shukry, M. & Miller, J. A. Update on dexmedetomidine: Use in nonintubated patients requiring sedation for surgical procedures. Therapeutics and Clinical Risk Management (2010). doi:10.2147/tcrm.s5374
12. Won, I., Laine, G. & Vallabh, M. 779: Safety and Efficacy of Dexmedetomidine in Nonintubated Patients for Delirium and Alcohol Withdrawal. Crit. Care Med. (2021). doi:10.1097/01.ccm.0000729004.15613.84
13. Lin, R. & Ansermino, J. M. Dexmedetomidine in paediatric anaesthesia. BJA Education (2020). doi:10.1016/j.bjae.2020.05.004
14. Mason, K. P. & Lerman, J. Dexmedetomidine in children: Current knowledge and future applications. Anesthesia and Analgesia (2011). doi:10.1213/ANE.0b013e31822b8629