Foreign Body Extraction: particularly in pediatric populations
Surgery: dexmedetomidine decreases inhalational anesthetic, sedative, and analgesic requirements
Sedation in the Intensive Care Unit (ICU) (see Sedation)
Clinical Efficacy
Dexmedetomidine to Lessen ICU Agitation (DahLIA) Trial: Comparison of Dexmedetomidine to Placebo in Agitated Delirium in Mechanically-Ventilated Patients in the Intensive Care Unit (JAMA, 2016) [MEDLINE]
Dexmedetomidine Increased Ventilator-Free Hours at 7 Days, as Compared to Usual Care
Dexmedetomidine Decreased Time to Extubation and Accelerated Resolution of Delirium
Meta-Analysis of Dexmedetomidine in ICU Sedation (Anaesth Crit Care Pain Med, 2016)[MEDLINE]
Dexmedetomidine was Associated with a 48 hr Reduction in ICU Length of Stay, Mechanical Ventilation Duration, and Duration of Delirium: despite significant heterogeneity among the studies
Dexmedetomidine was Associated with an Increased Risk of Bradycardia and Hypotension
Dexmedetomidine Decreases Benzodiazepine Dosing, Decreases Alcohol Withdrawal Scoring, and Blunts Hyperadrenergic Cardiovascular Responses (Ann Intensive Care, 2012) [MEDLINE]
Dexmedetomidine Can Be Used as an Adjunct to Benzodiazepines
Prospective Randomized Trial of Dexmedetomidine as Add-On Therapy to Lorazepam in Severe Alcohol Withdrawal (Crit Care Med, 2014) [MEDLINE]
Adjunctive Dexmedetomidine Maintains Symptom Control in Severe Alcohol Withdrawal, Decreasing Short-Term (But Not Long-Term) Lorazepam Use When Using a Symptom-Triggered Protocol
Monitoring for Bradycardia is Required with Dexmedetomidine and is Less Significant with Lower Infusion Rates
Retrospective Cohort Study of Dexmedetomidine vs Benzodiazepines in Alcohol Withdrawal (Pharmacotherapy, 2014) [MEDLINE]
Adjunctive Dexmedetomidine Manifested a Benzodiazepine-Sparing Effect in Alcohol Withdrawal
Although the Total Cost of Hospitalization was Similar Between the Groups, Dexmedetomidine was Associated with a Higher Study Drug Cost Per Patient
Other Uses
Cancer-Related Intractable Pain/Agitation/Delirium (J Pain Palliative Care Pharmacotherapy, 2006) [MEDLINE]
Dexmedetomidine as adjunct treatment for severe alcohol withdrawal in the ICU. Ann Intensive Care. 2012 May 23;2(1):12. doi: 10.1186/2110-5820-2-12 [MEDLINE]
A randomized, double-blind, placebo-controlled dose range study of dexmedetomidine as adjunctive therapy for alcohol withdrawal. Crit Care Med. 2014 May;42(5):1131-9. doi: 10.1097/CCM.0000000000000141 [MEDLINE]
Comparison of clinical outcomes in nonintubated patients with severe alcohol withdrawal syndrome treated with continuous-infusion sedatives: dexmedetomidine versus benzodiazepines. Pharmacotherapy. 2014 Sep;34(9):910-7. doi: 10.1002/phar.1448. Epub 2014 Jun 5 [MEDLINE]
Indications-Intensive Care Unit Sedation
Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Crit Care Med. 1995;23:1596-1600
Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 1996; 335:1864-1869 [MEDLINE]
The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest 1998; 114:541-548
Sedation, where are we now? Intensive Care Med 1999; 25:137-139
Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477 [MEDLINE]
Hyperlactatemia, increased osmolar gap, and renal dysfunction during continuous lorazepam infusion. Crit Care Med. 2000;28:1631-1634
Short-term lorazepam infusion and concern for propylene glycol toxicity. Pharmacotherapy 2001; 21:1140
Severe hyperosmolar metabolic acidosis due to a large dose of intravenous lorazepam. N Engl J Med 2002; 346:1253
The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med. 2003;168:1457-1461 [MEDLINE]
Daily interruption of sedative infusions and complications of critical illness in mechanically ventilated patients. Crit Care Med. 2004;32:1272-1276 [MEDLINE]
Dexmedetomidine a novel analgesic with palliative medicine potential. J Pain and Palliative Care Pharmacotherapy 2006; 20 (2): 23–7. doi:10.1080/J354v20n02_05 [MEDLINE]
Relationship of continuous infusion lorazepam to serum propylene glycol concentration in critically ill adults. Crit Care Med 2004; 32:1709-1714
Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy. 2005 May;25(5 Pt 2):8S-18S [MEDLINE]
Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial”. JAMA 2007; 298 (22): 2644–53 [MEDLINE]
Central sympatholysis as a novel countermeasure for cocaine-induced sympathetic activation and vasoconstriction in humans. J Am Coll Cardiol 2007; 50 (7): 626–33. doi:10.1016/j.jacc.2007.03.060 [MEDLINE]
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008 Jan 12;371(9607):126-34 [MEDLINE]
Dexmedetomidine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial. Crit Care 2009;13:R75 [MEDLINE]
Dexmedetomidine vs Midazolam for Sedation of Critically Ill Patients: A Randomized Trial”. JAMA 2009; 301 (5): 489–99 [MEDLINE]
Sedation Management in Australian and New Zealand Intensive Care Units: Doctors’ and Nurses’ Practices and Opinions”. Am J Crit Care 2009; 19 (3): 285–95 [MEDLINE]
A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit. Crit Care Med 2010; 38 (2): 497–503 [MEDLINE]
Role of α2-agonists in the treatment of acute alcohol withdrawal. Ann Pharmacother. 2011 May;45(5):649-57. doi: 10.1345/aph.1P575. Epub 2011 Apr 26 [MEDLINE]
Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA. 2012 Mar 21;307(11):1151-60 [MEDLINE]
American College of Critical Care Medicine: Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013, 41:263-306 [MEDLINE]
DahLIA Trial: Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium. JAMA. 2016 Mar 15. doi: 10.1001/jama.2016.2707 [MEDLINE]
Efficacy and safety of sedation with dexmedetomidine in critical care patients: a meta-analysis of randomized controlled trials. Anaesth Crit Care Pain Med. 2016 Feb;35(1):7-15. doi: 10.1016/j.accpm.2015.06.012. Epub 2015 Dec 11 [MEDLINE]
