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| REVIEW ARTICLE |
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| Year : 2011 | Volume
: 5
| Issue : 2 | Page : 128-133 |
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Current role of dexmedetomidine in clinical anesthesia and intensive care
Manpreet Kaur1, PM Singh2
1 Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, J.P.N.A Trauma Centre, New Delhi, India
2 Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| Date of Web Publication | 9-Apr-2012 |
Correspondence Address:
Manpreet Kaur
Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A Trauma Centre, New Delhi - 110 029
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0259-1162.94750
 Abstract | | |
Dexmedetomidine is a new generation highly selective α 2-adrenergic receptor (α 2-AR) agonist that is associated with sedative and analgesic sparing effects, reduced delirium and agitation, perioperative sympatholysis, cardiovascular stabilizing effects, and preservation of respiratory function. The aim of this review is to present the most recent topics regarding the advantages in using dexmedetomidine in clinical anesthesia and intensive care, while discussing the controversial issues of its harmful effects. Keywords: Dexmedetomidine, intensive care unit sedation, α 2-adrenergic receptor agonist
How to cite this article:
Kaur M, Singh P M. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res 2011;5:128-33 |
| Introduction | |  |
α 2-adrenergic receptor (α 2-AR) agonists have been successfully used in several clinical settings in view of diverse actions which include sedation, analgesia, anxiolysis, perioperative sympatholysis, cardiovascular stabilizing effects, reduced anesthetic requirements, and preservation of respiratory function. [1] Dexmedetomidine is a relatively new drug approved at the end of 1999 by the Food and Drug Administration (FDA) for humans use for short-term sedation and analgesia (<24 hours) in the intensive care unit (ICU). Dexmedetomidine is a useful sedative agent with analgesic properties, hemodynamic stability and ability to recover respiratory function in mechanically ventilated patients facilitating early weaning. [2] Besides being a new modality of sedation and analgesia in ICU patient management, [3] it has been studied in several other perioperative settings, which will be discussed.
| Chemical Structure | | |
Dexmedetomidine is the dextrorotatory S-enantiomer of medetomidine, an agent used in veterinary medicine. [4] It is chemically (S)-4-[1-(2,3-dimethylphenyl) ethyl]-3H-imidazole [Figure 1].
| Mechanism of Action | | |
α 2-AR agonists produce clinical effects after binding to G-Protein-coupled α 2-AR, of which there are three subtypes (α 2A, α 2B, and α 2C) with each having different physiological functions and pharmacological activities. These receptor subtypes are found ubiquitously in the central, peripheral, and autonomic nervous systems, as well as in vital organs and blood vessels. [5] Dexmedetomidine is 8 to 10 times more selective towards α 2-AR than clonidine. [6] Neither clonidine nor dexmedetomidine is totally selective for any one of the α 2-AR subtypes, but dexmedetomidine seems to have higher α2A-AR and α 2C-AR affinity than clonidine. [7] Major differences in the pharmacology of clonidine and dexmedetomidine have been described in [Table 1].
Locus ceruleus of the brain stem is the principal site for the sedative action and spinal cord is the principal site for the analgesic action, both acting through α 2A-AR. In the heart, the dominant action of α 2-AR agonists is a decrease in tachycardia (through blocking cardioaccelerator nerve) and bradycardia via α 2A-AR (through a vagomimetic action). In the peripheral vasculature, there is sympatholysis-mediated vasodilatation and smooth muscle cells receptor-mediated vasoconstriction. [8] The mechanism for the antishivering and diuretic actions has yet to be established firmly [9] [Figure 2].
The responses to activation of the receptors in other areas include decreased salivation, decreased secretion, and decreased bowel motility in the gastrointestinal tract; contraction of vascular and other smooth muscle; inhibition of renin release, increased glomerular filtration, and increased secretion of sodium and water in the kidney; decreased intraocular pressure; and decreased insulin release from the pancreas. [10] Combining all these effects, dexmedetomidine avoids some of the side effects of multiagent therapies.
| Pharmacokinetics | | |
Absorption and distribution
Dexmedetomidine exhibits linear pharmacokinetics in the recommended dose range of 0.2 to 0.7 μg/ kg/ hr administered as intravenous infusion up to 24 hours. The distribution phase is rapid, with a half-life of distribution of approximately 6 minutes and elimination half life of 2 hours. The steady-state volume of distribution is 118 L. The average protein binding is 94% and is constant across the different plasma concentrations and also similar in males and females. It has negligible protein binding displacement by drugs commonly used during anesthesia and in the ICU like fentanyl, ketorolac, theophylline, digoxin, and lidocaine. [10] Context-sensitive half life ranges from 4 minutes after a 10-minute infusion to 250 minutes after an 8-hour infusion. Oral bioavailability is poor because of extensive first-pass metabolism. However, bioavailability of sublingually administered dexmedetomidine is high (84%), offering a potential role in pediatric sedation and premedication. [11]
Metabolism and excretion
Dexmedetomidine undergoes almost complete biotransformation through direct N-glucuronidation and cytochrome P-450 (CYP 2A6)-mediated aliphatic hydroxylation to inactive metabolites. Metabolites are excreted in the urine (about 95%) and in the feces (4%). [10] Dose adjustments are required in patients with hepatic failure because of lower rate of metabolism.
| Clinical Pharmacology | | |
Cardiovascular system
Dexmedetomidine evokes a biphasic blood pressure response: A short hypertensive phase and subsequent hypotension. The two phases are considered to be mediated by two different α 2-AR subtypes: the α -2B AR is responsible for the initial hypertensive phase, whereas hypotension is mediated by the α 2A-AR. [12] In younger patients with high levels of vagal tone, bradycardia and sinus arrest have been described which were effectively treated with anticholinergic agents (atropine, glycopyrrolate).
Central nervous system
Dexmedetomidine reduces cerebral blood flow and cerebral metabolic requirement of oxygen but its effect on intracranial pressure (ICP) is not yet clear. Dexmedetomidine modulates spatial working memory, enhancing cognitive performance besides having sedative, analgesic, and anxiolytic action through the α 2-AR. [13] Studies suggest the likelihood of its neuroprotective action by reducing the levels of circulating and brain catecholamines and thus balancing the ratio between cerebral oxygen supplies, reducing excitotoxicity, and improving the perfusion in the ischemic penumbra. It reduces the levels of the glutamate responsible for cellular brain injury, especially in subarachnoid hemorrhage. [14] It has been shown to limit the morphologic and functional effects after ischemic (focal and global) and traumatic injury to the nervous system.
Respiratory effects
Dexmedetomidine affect on respiration appears to be similar in order of magnitude to those seen in the heavy sleep state. [15] Dexmedetomidine does not suppress respiratory function, even at high doses. [16] It has no adverse effects on respiratory rate and gas exchange when used in spontaneously breathing ICU patients after surgery. [15] It helps in maintaining sedation without cardiovascular instability or respiratory drive depression and hence may facilitate weaning and extubation in trauma/surgical ICU patients who have failed previous attempts at weaning because of agitation and hyperdynamic cardiopulmonary response. [2],[17]
Endocrine and renal effects
Dexmedetomidine activates peripheral presynaptic α 2- AR which reduces the release of catecholamines, and hence reduces sympathetic response to surgery. [18] Animal studies have demonstrated the occurrence of natriuresis and diuresis. Dexmedetomidine is an imidazole agent but unlike etomidate, it does not appear to inhibit steroidogenesis when used as an infusion for short-term sedation. [19]
| Adverse Effects | | |
The various reported side effects are hypotension, hypertension, nausea, vomiting, dry mouth, bradycardia, atrial fibrillation, pyrexia, chills, pleural effusion, atelectasis, pulmonary edema, hyperglycemia, hypocalcaemia, acidosis, etc. Rapid administration of dexmedetomidine infusion (Loading dose of 1 μ/ kg/ hr if given in less than 10 minutes) may cause transient hypertension mediated by peripheral α 2B- AR vasoconstriction. [5] But hypotension and bradycardia may occur with ongoing therapy mediated by central α 2A-AR, causing decreased release of noradrenaline from the sympathetic nervous system. Long-term use of dexmedetomidine leads to super sensitization and upregulation of receptors; so, with abrupt discontinuation, a withdrawal syndrome of nervousness, agitation, headaches, and hypertensive crisis can occur. [20] Dexmedetomidine is not recommended in patients with advanced heart block and ventricular dysfunction. [5] FDA has classified it as a category C pregnancy risk, so the drug should be used with extreme caution in women who are pregnant.
| Clinical Applications of Dexmedetomidine | | |
Premedication
Dexmedetomidine is used as an adjuvant for premedication, especially in patients susceptible to preoperative and perioperative stress because of its sedative, anxiolytic, analgesic, sympatholytic, and stable hemodynamic profile. Dexmedetomidine decreases oxygen consumption in intraoperative period (up to 8%) and in postoperative period (up to 17%). [21] Premedication dose is 0.33 to 0.67 mg/kg IV given 15 minutes before surgery (this dose minimizes side effects of hypotension and bradycardia).
Intraoperative use
Dexmedetomidine attenuates hemodynamic stress response to intubation and extubation by sympatholysis. [15],[22],[23],[24] In view of absent respiratory depression, it can be continued at extubation period unlike other drugs. Dexmedetomidine potentiates anesthetic effect of all the anesthetic agents irrespective of the mode of administration (intravenous, inhalation, regional block). Intraoperative administration of dexmedetomidine in lower concentrations has reduced the requirement of other anesthetic agents; fewer interventions to treat tachycardia; and a reduction in the incidence of myocardial ischemia. [23] However, side effects like bradycardia and hypotension are limitations to its use necessitating need for pharmacological rescue therapy. These effects may be attributed to the combined properties of volatile anesthetics such as vasodilatation and myocardial depression. Dexmedetomidine administered in high concentrations may cause systemic and pulmonary hypertension because of direct peripheral vascular effects or may compromise myocardial function and blood pressure.
Locoregional analgesia
Highly lipophilic nature of dexmedetomidine allows rapid absorption into the cerebrospinal fluid and binding to α 2-AR of spinal cord for its analgesic action. It prolongs the duration of both sensory and motor blockade induced by local anesthetics irrespective of the route of administration (e.g., epidural, [25] caudal, [26] or spinal [27] ). Dexmedetomidine though enhances both central and peripheral neural blockade by local anesthetics; [27] however, the peripheral neural blockade is due to its binding to α 2A-AR. [28] Dexmedetomidine has been successfully used in intravenous regional anesthesia (IVRA), [29] brachial plexus block, [30] and intraarticularly. [31],[32] Addition of 0.5 μg/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and improves intraoperative-postoperative analgesia without causing side effects. [29] Dexmedetomidine added to levobupivacaine for axillary brachial plexus block shortens the onset time and prolongs the duration of the block and postoperative analgesia. [30] Intraarticular dexmedetomidine in patients undergoing arthroscopic knee surgery improves the quality and duration of postoperative analgesia. [31],[32]
Sedation in intensive care unit
Dexmedetomidine has become popular sedative agent in ICU because of its ability to produce cooperative sedation, i.e., patients remain awake, calm, and are able to communicate their needs. It does not interfere with the respiratory drive or produce any agitation, hence facilitating early weaning from ventilator, thereby reducing overall ICU stay costs. [33] The maintenance of natural sleep during sedation might speed recovery time in the ICU. Dexmedetomidine currently is approved by FDA for use in ICU for not more than 24 hours; though many studies have reported its safe use for longer duration. [34] Dexmedetomidine, when compared with conventional sedatives and opiates [Table 2], has been demonstrated to be associated with both sedative and analgesic sparing effects, reduced delirium and agitation, minimal respiratory depression, and desirable cardiovascular effects. [2],[35],[36]
Procedural sedation
Dexmedetomidine is an attractive agent for short-term procedural sedation and has been safely used in transesophageal echocardiography, [37] colonoscopy, [38] awake carotid endarterectomy, [39] shockwave lithotripsy, [34] vitreoretinal surgery, [40] elective awake fiberoptic intubation, [41] pediatric patients undergoing tonsillectomy, [42] and pediatric MRI. [43] The usual dose of dexmedetomidine for procedural sedation is 1 μg/ kg, followed by an infusion of 0.2 μg/kg/h. Its onset of action is less than 5 minutes and the peak effect occur within 15 minutes. As the pharmacologic effects of dexmedetomidine can be reversed by the α 2-AR antagonist atipamezole, [44] dexmedetomidine provides a titratable form of hypnotic sedation that can be readily reversed.
Controlled hypotension
Dexmedetomidine is an effective and safe agent for controlled hypotension mediated by its central and peripheral sympatholytic action. Its easy administration, predictability with anesthetic agents, and lack of toxic side effect while maintaining adequate perfusion of the vital organs makes it a near-ideal hypotensive agent. Spinal fusion surgery for idiopathic scoliosis, [45] septoplasty and tympanoplasty operations, [46] and maxillofacial surgery [47] have been safely done with dexmedetomidine-controlled hypotension.
Analgesia
Dexmedetomidine activates α 2-AR in the spinal cord reducing transmission of nociceptive signals like substance P. It has significant opioid sparing effect and is useful in intractable neuropathic pain. [14]
Cardiac surgery
Dexmedetomidine in addition to blunting the hemodynamic response to endotracheal intubation also reduces the extent of myocardial ischemia during cardiac surgery. [48] Dexmedetomidine has been successfully used to manage patients with pulmonary hypertension undergoing mitral valve replacement, with reduction in pulmonary vascular resistance, pulmonary artery pressure, and pulmonary capillary wedge pressures. [5]
Neurosurgery
Dexmedetomidine provides stable cerebral hemodynamics without sudden increase in ICP during intubation, extubation, and head pin insertion. It attenuates neurocognitive impairment (delirium and agitation) allowing immediate postoperative neurological evaluation. It exerts its neuroprotective effects through several mechanisms which make the usage of this drug a promising tool during cerebral ischemia. [14] It does not interfere with neurological monitors [5] and has an upcoming role in "functional" neurosurgery. This includes awake craniotomy for the resection of tumors or epileptic foci in eloquent areas, and the implantation of deep brain stimulators for Parkinson's disease. [5]
Obesity
Dexmedetomidine does not cause respiratory depression and has been infused at a dose of 0.7 μg/kg intraoperatively to avoid respiratory depression due to narcotic usage in a morbidly obese patient. [49]
Obstetrics
Dexmedetomidine has been successfully used as an adjunct to unsatisfactory analgesia by systemic opioids in laboring parturients who could not benefit from epidural analgesia. [50] It provides maternal hemodynamic stability, anxiolysis, and stimulation of uterine contractions. It is retained in placental tissue and passes less readily into the fetal circulation than clonidine because of high lipophilicity and thereby has less susceptibility to cause fetal bradycardia.
Pediatrics
It is currently being used off-label as an adjunctive agent in pediatric patients for sedation and analgesia in the critical care unit and for sedation during noninvasive procedures in radiology like computed tomography and magnetic resonance imaging. [43]
Other uses
The literature suggests other potential uses for dexmedetomidine, for example
- Dexmedetomidine has been used successfully in the treatment of withdrawal from benzodiazepines, opioids, alcohol, and recreational drugs.
- As an adjunct in otorhinolaryngology anesthesia for middle ear surgery and rhinoplasty.
- As an adjunct in the repair of aortic aneurysms.
- Management of tetanus in ICU.
- As an antishivering agent.
- Dexmedetomidine is effective in preventing ethanol-induced neurodegeneration.
| Conclusion | | |
Dexmedetomidine because of its unique properties offers its promising use in wide spectrum of clinical settings and ICUs. It is a part of fast-tracking anesthesia regimens and offers anesthetic sparing and hemodynamic stabilizing effects. As pharmacological effects of dexmedetomidine can be reversed by α 2-AR antagonist atipamezole, combination of dexmedetomidine and atipamezole can provide titratable form of sedation in the future.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]
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Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty |
|
| Reza Jouybar, Maryam Nemati, Naeimehossadat Asmarian | | BMC Anesthesiology. 2022; 22(1) | | [Pubmed] | [DOI] | | | 10 |
Effects of intravenous dexmedetomidine on perioperative haemodynamics and quality of emergence in patients undergoing head and neck surgery following general anaesthesia—a comparative randomized, double-blind placebo-controlled study |
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| Venugopal Achuthan Nair, Divya V. Gladston, Jagathnath Krishna K. M., Rachel Cherian Koshy | | Ain-Shams Journal of Anesthesiology. 2022; 14(1) | | [Pubmed] | [DOI] | | | 11 |
Comparative study between ketamine-S-dexmedetomidine and ketamine-S-midazolam-methadone in the anesthesia of capuchin monkeys (Sapajus apella) |
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| Simone Marques Caramalac,Andreza Futado de Souza,Silvana Marques Caramalac,Verônica Batista de Albuquerque,Lucas Bezerra da Silva Azuaga,Fabrício de Oliveira Frazílio | | Ciência Rural. 2022; 52(4) | | [Pubmed] | [DOI] | | | 12 |
Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity? |
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| Shweta Murlidhar Patil, Anendd Jadhav, Nitin Bhola, Pawan Hingnikar, Krutarth Kshirsagar, Dipali Patil | | Journal of Dental Anesthesia and Pain Medicine. 2022; 22(2): 145 | | [Pubmed] | [DOI] | | | 13 |
Dexmedetomidine and LPS co-treatment attenuates inflammatory response on WISH cells via inhibition of p38/NF-?B signaling pathway |
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| Tae-Sung Kim, Ji-Young Yoon, Cheul-Hong Kim, Eun-Ji Choi, Yeon Ha Kim, Eun-Jung Kim | | Journal of Dental Anesthesia and Pain Medicine. 2022; 22(4): 277 | | [Pubmed] | [DOI] | | | 14 |
Case series: Opioid free anaesthesia |
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| Sai Krishna J | | Indian Journal of Clinical Anaesthesia. 2022; 9(3): 379 | | [Pubmed] | [DOI] | | | 15 |
A COMPARATIVE STUDY OF DEXMEDETOMIDINE AND CLONIDINE AS AN ADJUVANT TO ROPIVACAINE IN SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK |
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| NAGALINGAM NATARAJAN, GOPALAKRISHNAN KUPPUSAMY, AISHWARYA RAMANATHAN, SMITUL DAVE | | Asian Journal of Pharmaceutical and Clinical Research. 2022; : 119 | | [Pubmed] | [DOI] | | | 16 |
Benefits of dexmedetomidine on postoperative analgesia after bariatric surgery |
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| Chenchen TIAN, Roshan S. MALHAN, Shirley X. DENG, Yung LEE, Joshua PEACHEY, Mandeep SINGH, Dennis HONG | | Minerva Anestesiologica. 2022; 88(3) | | [Pubmed] | [DOI] | | | 17 |
Meldonium Ameliorates Hypoxia-Induced Lung Injury and Oxidative Stress by Regulating Platelet-Type Phosphofructokinase-Mediated Glycolysis |
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| Daohui Wang, Fengying Liu, Weijie Yang, Yangyang Sun, Xiaoning Wang, Xin Sui, Jun Yang, Qian Wang, Wenhao Song, Minmin Zhang, Zhenyu Xiao, Tian Wang, Yongan Wang, Yuan Luo | | Frontiers in Pharmacology. 2022; 13 | | [Pubmed] | [DOI] | | | 18 |
Nocturnal dexmedetomidine for prevention of delirium in critically ill surgical patients: a randomized control trial protocol |
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| Raksakul Kuanha, Thanus Teeratitayang-gool, Annop Piriyapassom, Nuanprae Kitisin, Napat Thikom, Onuma Chaiwat | | Clinical Critical Care. 2022; | | [Pubmed] | [DOI] | | | 19 |
Evaluation of Nebulised Dexmedetomidine Given Pre-operatively to Attenuate Hemodynamic Response to Laryngoscopy and Endotracheal Intubation: A Randomised Control Trial |
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| Priyanka Shrivastava, Mukesh Kumar, Saket Verma, Ridhima Sharma, Raman Kumar, Ravi Ranjan, Jay Prakash | | Cureus. 2022; | | [Pubmed] | [DOI] | | | 20 |
A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars |
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| ShubhadaHarishchandra Nalawade,Kumar Nilesh,CD Mounesh Kumar,PrashantA Punde,PankajB Patil | | National Journal of Maxillofacial Surgery. 2021; 12(2): 255 | | [Pubmed] | [DOI] | | | 21 |
Role of a2-Adrenoceptor Subtypes in Suppression of L-Type Ca2+ Current in Mouse Cardiac Myocytes |
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| Edward V. Evdokimovskii,Ryounghoon Jeon,Sungjo Park,Oleg Y. Pimenov,Alexey E. Alekseev | | International Journal of Molecular Sciences. 2021; 22(8): 4135 | | [Pubmed] | [DOI] | | | 22 |
A Narrative Overview of Current Anesthetic Drugs in Electroconvulsive Therapy |
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| Kevin Lee,Kimberly D. Jenkins,Tanaya Sparkle | | Life. 2021; 11(9): 981 | | [Pubmed] | [DOI] | | | 23 |
A COMPARATIVE STUDY OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE AS ADJUNCT TO LIDOCAINE IN INTRAVENOUS REGIONAL ANESTHESIA |
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| Diana Salam Sami, Ali Hadi Muslih | | Wiadomosci Lekarskie. 2021; 74(9): 2259 | | [Pubmed] | [DOI] | | | 24 |
Dexmedetomidine inhibits unstable motor network in patients with primary motor area gliomas |
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| Tao Yu,Songlin Yu,Zhentao Zuo,Nan Lin,Jing Wang,Yuanli Zhao,Song Lin | | Aging. 2021; 13(11): 15139 | | [Pubmed] | [DOI] | | | 25 |
A comparative study to assess the efficacy of addition of dexmedetomidine to levobupivacaine in brachial plexus block |
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| Shabeel Aboobacker C P,Shamjith K,Melbin Baby,Salman Mohammed Kutty C | | Indian Journal of Clinical Anaesthesia. 2021; 8(2): 155 | | [Pubmed] | [DOI] | | | 26 |
A Prospective Study of Dexmedetomidine as an Adjuvant to Local Anaesthetic Used in Supraclavicular Block |
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| Paidikondala L.R.N.N.,Kommula Gopala Krishna,Subhamani P,Sudhir Sirkar P | | Journal of Evidence Based Medicine and Healthcare. 2021; 8(07): 345 | | [Pubmed] | [DOI] | | | 27 |
The effect of dexmedetomidine on gastric ischemia reperfusion injury in rats. Biochemical and histopathological evaluation |
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| Ufuk Kuyrukluyildiz,Leman Acun Delen,Didem Onk,Gulce Naz Yazici,Mine Gulaboglu,Halis Suleyman | | Acta Cirúrgica Brasileira. 2021; 36(1) | | [Pubmed] | [DOI] | | | 28 |
Probable Dexmedetomidine Induced Diabetes Insipidus: A Case Review |
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| Sonika Vani, Abbey Stackpole, Mary P. Kovacevic | | Journal of Pharmacy Practice. 2021; : 0897190021 | | [Pubmed] | [DOI] | | | 29 |
Comparing the effects of dexmedetomidine versus propofol on the treatment of emergence agitation in adult patients after general anesthesia: study protocol for a randomized, superiority, controlled trial (DP-TEA Trial) |
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| Zhaoyan Feng, Xiao Shi, Xue Yan, Yamin Zhu, Juan Gu, Hao Zhu, Weifeng Yu, Song Zhang | | Trials. 2021; 22(1) | | [Pubmed] | [DOI] | | | 30 |
Intranasal versus sublingual route of dexmedetomidine sedation in paediatric dentistry: A randomized controlled clinical trial |
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| Mai A. Shaat,Niveen S. Bakry,Ahmed M. Elshafie,Dalia M. Talaat | | International Journal of Paediatric Dentistry. 2021; | | [Pubmed] | [DOI] | | | 31 |
The Association of Dexmedetomidine with Firing Properties in Pallidal Neurons |
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| Majid Gasim,Suneil K. Kalia,Mojgan Hodaie,Andres M. Lozano,Lakshmikumar Venkatraghavan,William D. Hutchison | | Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2021; 48(4): 525 | | [Pubmed] | [DOI] | | | 32 |
Dexmedetomidine does not compromise neuronal viability, synaptic connectivity, learning and memory in a rodent model |
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| Nerea Jimenez-Tellez,Fahad Iqbal,Marcus Pehar,Alberto Casas-Ortiz,Tiffany Rice,Naweed I. Syed | | Scientific Reports. 2021; 11(1) | | [Pubmed] | [DOI] | | | 33 |
An Opioid-free Anesthesia Protocol for Pediatric Strabismus Surgery: A Quality Improvement Project |
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| Jennifer L. Chiem,Laura D. Donohue,Lynn D. Martin,Daniel K. Low | | Pediatric Quality & Safety. 2021; 6(5): e462 | | [Pubmed] | [DOI] | | | 34 |
Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Assessment and Treatment Challenges |
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| Salia Farrokh,Christina Roels,Kent A. Owusu,Sarah E. Nelson,Aaron M. Cook | | Neurocritical Care. 2021; 34(2): 593 | | [Pubmed] | [DOI] | | | 35 |
Near ideal anesthetic technique for tracheal stenting in central airway obstruction with dexmedetomidine-ketamine infusion: a case report |
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| Sakshi Thakore,Nishkarsh Gupta,Karan Madan,Sushma Bhatnagar | | Brazilian Journal of Anesthesiology (English Edition). 2021; 71(4): 447 | | [Pubmed] | [DOI] | | | 36 |
Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis |
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| Francisca Jerónimo Fonseca, Leonardo Ferreira, Ana Lídia Rouxinol-Dias, Joana Mourão | | Brazilian Journal of Anesthesiology (English Edition). 2021; | | [Pubmed] | [DOI] | | | 37 |
Endoscope-assisted techniques for evacuation of acute subdural haematoma in the elderly: The lesser of two evils? A scoping review of the literature |
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| R.J. Spencer,S. Manivannan,M. Zaben | | Clinical Neurology and Neurosurgery. 2021; 207: 106712 | | [Pubmed] | [DOI] | | | 38 |
Acute poisoning by dexmedetomidine-containing chewing gum in a child |
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| Candace Y. Chan, Magdalene H.Y. Tang, K.C. Wong, Y.K. Chong, K.Y. Yeung, Tony W.L. Mak | | Pathology. 2021; | | [Pubmed] | [DOI] | | | 39 |
Noradrenaline in the aging brain: Promoting cognitive reserve or accelerating Alzheimeræs disease? |
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| Mara Mather | | Seminars in Cell & Developmental Biology. 2021; 116: 108 | | [Pubmed] | [DOI] | | | 40 |
Dexmedetomidine protects against degeneration of dopaminergic neurons and improves motor activity in Parkinsonæs disease mice model |
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| Bao-ping Zhang,Li Wu,Xian-wei Wu,Fang Wang,Xin Zhao | | Saudi Journal of Biological Sciences. 2021; 28(6): 3198 | | [Pubmed] | [DOI] | | | 41 |
Emergence Delirium in Perioperative Pediatric Care: A Review of Current Evidence and New Directions |
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| Ivan Urits,Jacquelin Peck,Stephen Giacomazzi,Riki Patel,John Wolf,Denzil Mathew,Ruben Schwartz,Hisham Kassem,Richard D. Urman,Alan D. Kaye,Omar Viswanath | | Advances in Therapy. 2020; 37(5): 1897 | | [Pubmed] | [DOI] | | | 42 |
The effect of dexmedetomidine on motor-evoked potentials during pediatric posterior spinal fusion surgery: a retrospective case-control study |
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| Francesca Holt, Samuel Strantzas, Christian Zaarour, Racha Chamlati, Ian Vreugdenhil, Igor Luginbuehl, Cengiz Karsli, David Faraoni | | Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2020; 67(10): 1341 | | [Pubmed] | [DOI] | | | 43 |
Dexmedetomidine infusion for sedation in a patient with myotonic dystrophy* |
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| A. Y. Liu,A. Dower,S. Nair | | Anaesthesia Reports. 2020; 8(2): 135 | | [Pubmed] | [DOI] | | | 44 |
Perioperative Dexmedetomidine Fails to Improve Postoperative Analgesic Consumption and Postoperative Recovery in Patients Undergoing Lateral Thoracotomy for Thoracic Esophageal Cancer: A Randomized, Double-Blind, Placebo-Controlled Trial |
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| Yu Mao,Xuemei Sun,Li Si,Lijian Chen,Xuesheng Liu,Zhi Zhang,Erwei Gu | | Pain Research and Management. 2020; 2020: 1 | | [Pubmed] | [DOI] | | | 45 |
Review of nonopioid multimodal analgesia for surgical and trauma patients |
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| Stephy George,Meagan Johns | | American Journal of Health-System Pharmacy. 2020; 77(24): 2052 | | [Pubmed] | [DOI] | | | 46 |
Has the future arrived? Liposomal bupivacaine versus perineural catheters and additives for interscalene brachial plexus block |
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| Steven L. Orebaugh,Anu Dewasurendra | | Current Opinion in Anaesthesiology. 2020; 33(5): 704 | | [Pubmed] | [DOI] | | | 47 |
Opioids and alpha-2-agonists for analgesia and sedation in newborn infants: protocol of a systematic review |
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| Mari Kinoshita,Katarzyna Stempel,Israel Junior Borges do Nascimento,Dhashini Naidu Vejayaram,Elisabeth Norman,Matteo Bruschettini | | Systematic Reviews. 2020; 9(1) | | [Pubmed] | [DOI] | | | 48 |
Comparative study between the effect of dexmedetomidine and lidocaine infusion in lumbar fixation on hemodynamics, fentanyl requirements, and postoperative analgesia |
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| Nayera S. Mohammed,Mariam K. Habib,Essam A. Abbas,Sahar M. Mahmoud,Ibraheem A. Ramadan | | Ain-Shams Journal of Anesthesiology. 2020; 12(1) | | [Pubmed] | [DOI] | | | 49 |
Dexmedetomidine inhibits inflammatory response and autophagy through the circLrp1b/miR-27a-3p/Dram2 pathway in a rat model of traumatic brain injury |
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| Hengchang Li,Chengxiang Lu,Wenfei Yao,Lixin Xu,Jun Zhou,Bin Zheng | | Aging. 2020; 12(21): 21687 | | [Pubmed] | [DOI] | | | 50 |
The Effect of Different Doses of Intravenous Dexmedetomidine on the Properties of Subarachnoid Blockade: A Systematic Review and Meta-Analysis |
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| Mohammad K Al Nobani,Mohammed A Ayasa,Tarek A Tageldin,Abduljabbar Alhammoud,Marcus Daniel Lance | | Local and Regional Anesthesia. 2020; Volume 13: 207 | | [Pubmed] | [DOI] | | | 51 |
Experience with the dexmedetomidine for sedation in pediatric neurosurgery in the early postoperative period |
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| L.V. Havrylova | | Endovascular Neuroradiology. 2020; 33(3): 56 | | [Pubmed] | [DOI] | | | 52 |
Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill Patients: Basic and Clinical Approaches |
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| Rodrigo L. Castillo,Mauricio Ibacache,Ignacio Cortínez,Catalina Carrasco-Pozo,Jorge G. Farías,Rodrigo A. Carrasco,Patricio Vargas-Errázuriz,Daniel Ramos,Rafael Benavente,Daniela Henríquez Torres,Aníbal Méndez | | Frontiers in Pharmacology. 2020; 10 | | [Pubmed] | [DOI] | | | 53 |
Effects of local dexmedetomidine administration on the neurotoxicity of ropivacaine for sciatic nerve block in rats |
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| Xing Xue,Jun Fan,Xiaoli Ma,Yongqiang Liu,Xuena Han,Yufang Leng,Jinjia Yu | | Molecular Medicine Reports. 2020; | | [Pubmed] | [DOI] | | | 54 |
Comparison of efficacy and safety of dexmedetomidine versus propofol infusion for maintaining depth of general anesthesia when muscle relaxants are not used |
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| Pulak Tosh,Sunil Rajan,Naina Narayani,KarthikChandra Babu,Niranjan Kumar,Jerry Paul | | Bali Journal of Anesthesiology. 2020; 4(2): 42 | | [Pubmed] | [DOI] | | | 55 |
A comparative study of ropivacaine versus ropivacaine plus dexmedetomidine under epidural anesthesia in lower limb surgeries |
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| AshemJack Meitei,Tikendrajit Ningombam,TakhelmayumHemjit Singh,Gojendra Rajkumar,NAnita Devi,YumnamArunkumar Singh | | Journal of Medical Society. 2019; 33(1): 20 | | [Pubmed] | [DOI] | | | 56 |
Intravenous anaesthetics |
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| Jarmila Drábková | | Klinická farmakologie a farmacie. 2019; 33(2): 15 | | [Pubmed] | [DOI] | | | 57 |
The Role of Heme Oxygenase-1 in Remote Ischemic and Anesthetic Organ Conditioning |
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| A. Raffaele Bauer,A. Raffaele Raupach | | Antioxidants. 2019; 8(9): 403 | | [Pubmed] | [DOI] | | | 58 |
Xenon anesthesia for awake craniotomy: safety and efficacy |
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| Alexander Kulikov,Federico Bilotta,Beatrice Borsellino,Denis Selækov,Grigory Kobyakov,Andrey Lubnin | | Minerva Anestesiologica. 2019; 85(2) | | [Pubmed] | [DOI] | | | 59 |
Efficacy of Dexmedetomidine Infusion Without Loading Dose as a Potent Hypotensive Agent in Lumbar Fixation Surgery |
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| Assem Adel Moharram,Raham Hasan Mostafa | | The Open Anesthesia Journal. 2019; 13(1): 68 | | [Pubmed] | [DOI] | | | 60 |
Addition of dexmedetomidine to bupivacaine in Transversus Abdominis Plane Block in Inguinal Hernia Repair: A Perspective Double Blind Study |
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| . Royzada B,Kujur S.,Royzada A.,Pandey S. | | Journal of Evidence Based Medicine and Healthcare. 2019; 6(45): 2904 | | [Pubmed] | [DOI] | | | 61 |
Comparative evaluation of intrathecal bupivacaine alone and bupivacaine combined with dexmedetomidine in cesarean section using spinal anesthesia: a meta-analysis |
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| Xin Liu,Xiongjie Zhang,Xujian Wang,Jinyan Wang,Hao Wang | | Journal of International Medical Research. 2019; 47(7): 2785 | | [Pubmed] | [DOI] | | | 62 |
Antiemetic efficacy of dexmedetomidine versus dexmedetomidine-dexamethasone combination in patients undergoing breast surgery |
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| HyunJeong Kwak,Young Jin Chang,Kyung Cheon Lee,Wol Seon Jung,Sunkoo Kwon,Youn Yi Jo | | Journal of International Medical Research. 2019; 47(10): 5060 | | [Pubmed] | [DOI] | | | 63 |
Fluid loading during spinal anesthesia can reduce bradycardia after intravenous dexmedetomidine infusion |
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| Wonjin Lee,Yongjae Han,Se Hun Lim,Sung-ho Moon,Kwangrae Cho,Myoung-hun Kim | | Anesthesia and Pain Medicine. 2019; 14(1): 19 | | [Pubmed] | [DOI] | | | 64 |
Tendencies and perspectives of central alpha2-adrenomimetic application in medicobiological research |
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| Nikolay G. Vengerovich,Igor M. Ivanov,Yulia A. Proshina | | Pharmacy Formulas. 2019; 1(1): 70 | | [Pubmed] | [DOI] | | | 65 |
DEXMEDETOMIDINE: A WONDER DRUG FOR TAP BLOCK IN PATIENTS UNDERGOING ELECTIVE CAESAREAN SECTION FOR POSTOPERATIVE PAIN RELIEF |
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| Ujjwala Sumedh Andurkar,Maneesha Rajendrakumar Suryavanshi | | Journal of Evidence Based Medicine and Healthcare. 2018; 5(28): 2139 | | [Pubmed] | [DOI] | | | 66 |
Midazolam and Dexmedetomidine Affect Neuroglioma and Lung Carcinoma Cell Biology In Vitro and In Vivo |
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| Chunyan Wang,Tanweer Datoo,Hailin Zhao,Lingzhi Wu,Akshay Date,Cui Jiang,Robert D. Sanders,Guolin Wang,Charlotte Bevan,Daqing Ma | | Anesthesiology. 2018; 129(5): 1000 | | [Pubmed] | [DOI] | | | 67 |
Dexmedetomidine as a part of general anaesthesia for caesarean delivery in patients with pre-eclampsia |
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| Ashraf M. Eskandr,Ahmed A. Metwally,Abd-Elrahman A. Ahmed,Elham M. Elfeky,Islam M. Eldesoky,Manar A. Obada,Osama A. Abd-Elmegid | | European Journal of Anaesthesiology. 2018; 35(5): 372 | | [Pubmed] | [DOI] | | | 68 |
Dexmedetomidine-assisted drug interviews: an observation in psychiatric setting |
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| Devalina Goswami,Harshit Garg,Hamsenandinie Carounagarane,Koushik Sinha Deb | | BMJ Case Reports. 2018; 11(1): e227195 | | [Pubmed] | [DOI] | | | 69 |
Sedation During Surgery for Movement Disorders and Perioperative Neurologic Complications: An Observational Study Comparing Local Anesthesia, Remifentanil, and Dexmedetomidine |
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| Cristina Honorato-Cia,Antonio Martinez-Simón,Jorge Guridi,Manuel Alegre,Jorge M. Nuñez-Cordoba | | World Neurosurgery. 2017; 101: 114 | | [Pubmed] | [DOI] | | | 70 |
Comparison of Efficacy of Bupivacaine with Dexmedetomidine Versus Bupivacaine Alone for Transversus Abdominis Plane Block for Post-operative Analgesia in Patients Undergoing Elective Caesarean Section |
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| A. Ramya Parameswari,Prabha Udayakumar | | The Journal of Obstetrics and Gynecology of India. 2017; | | [Pubmed] | [DOI] | | | 71 |
Alpha-2 Agonists |
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| Viet Nguyen,Dawn Tiemann,Edward Park,Ali Salehi | | Anesthesiology Clinics. 2017; | | [Pubmed] | [DOI] | | | 72 |
Perioperative analgesic profile of dexmedetomidine infusions in morbidly obese undergoing bariatric surgery: a meta-analysis and trial sequential analysis |
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| Preet Mohinder Singh,Rajesh Panwar,Anuradha Borle,Jan P. Mulier,Ashish Sinha,Basavana Goudra | | Surgery for Obesity and Related Diseases. 2017; | | [Pubmed] | [DOI] | | | 73 |
DEXMEDETOMIDINE AS AN ADJUVANT TO EPIDURAL ROPIVACAINE IN LOWER LIMB SURGERIES- A RANDOMISED CONTROL TRIAL |
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| Susanta Sarkar,Subhrajyoti Chattopadhyay,Saptarshi Bhattacharya,Mohanchandra Mandal,Piyali Chakrabarti,Suchitra Pal | | Journal of Evolution of Medical and Dental Sciences. 2017; 6(19): 1473 | | [Pubmed] | [DOI] | | | 74 |
Dexmedetomidine: an attractive adjunct to anesthesia |
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| Hong-Beom Bae | | Korean Journal of Anesthesiology. 2017; 70(4): 375 | | [Pubmed] | [DOI] | | | 75 |
Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries: A prospective, randomised, double-blinded clinical study |
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| Savita Gupta, Rashmi Sharma | | Indian Journal of Anaesthesia. 2017; 61(6): 499 | | [Pubmed] | [DOI] | | | 76 |
A STUDY OF MODIFIED ALDRETE’S SCORE POST EXTUBATION WHEN DEXMEDETOMIDINE IS USED ALONG WITH PROPOFOL AS INDUCING AGENT |
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| Sandeep Prithviraj Pandharpurkar | | Journal of Evidence Based Medicine and Healthcare. 2016; 3(86): 4713 | | [Pubmed] | [DOI] | | | 77 |
Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia |
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| Xiang Wu,Li-Hua Hang,Hong Wang,Dong-Hua Shao,Yi-Guo Xu,Wei Cui,Zheng Chen | | Yonsei Medical Journal. 2016; 57(4): 998 | | [Pubmed] | [DOI] | | | 78 |
INTRAVENOUS DEXMEDETOMIDINE FOR LABOUR ANALGESIA IN WOMEN WITH PREECLAMPSIA |
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| Nidhi Mishra,Amit Jain,Monica Sharma | | Journal of Evolution of Medical and Dental Sciences. 2016; 5(52): 3408 | | [Pubmed] | [DOI] | | | 79 |
Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis |
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| Chengmao Zhou,Yu Zhu,Zhen Liu,Lin Ruan | | Journal of International Medical Research. 2016; 44(6): 1182 | | [Pubmed] | [DOI] | | | 80 |
Dexmedetomidine versus labetalol infusions for controlling emergence hypertension in cranial surgeries for supratentorial tumors |
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| Tarek Ahmed Mostafa Radwan,Naser Ahmed Fadel,Rania Samir Fahmy,Mahmoud Yahiya Mustafa | | Egyptian Journal of Anaesthesia. 2016; | | [Pubmed] | [DOI] | | | 81 |
Intravenous labetolol in treating hypertensive crisis following dexmedetomidine infusion for procedural sedation |
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| Thilaka Muthiah,Amarnath Moni,Lailu Mathews,Sudarshan Balaji | | Journal of Clinical Anesthesia. 2016; 29: 30 | | [Pubmed] | [DOI] | | | 82 |
Efficacy of Intranasal Dexmedetomidine for Conscious Sedation in Patients Undergoing Surgical Removal of Impacted Third Molar: A Double-Blind Split Mouth Study |
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| Sujeeth Kumar Shetty,Garima Aggarwal | | Journal of Maxillofacial and Oral Surgery. 2016; | | [Pubmed] | [DOI] | | | 83 |
In reply: Assessing interaction between dexmedetomidine and propofol |
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| Ji Young Yoo,Jong Yeop Kim | | Journal of Anesthesia. 2016; | | [Pubmed] | [DOI] | | | 84 |
TO EVALUATE THE EFFICACY OF INTRATHECAL ISOBARIC 0.75% ROPIVACAINE WITH THE COMBINATION OF ISOBARIC 0.75% ROPIVACAINE AND DEXMEDETOMIDINE IN GERIATRIC HYPERTENSIVE PATIENTS UNDERGOING UROLOGICAL SURGERIES : A PROSPECTIVE, RANDOMISED, CONTROLLED, DOUBLE - BLIND STUDY |
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| Yerramsetti Atchyutha Ramaiah,Srinivasa Rao Manduri,Sowbhaghya Lakshmi B,Pydi Lalitha | | Journal of Evolution of Medical and Dental Sciences. 2015; 4(03): 329 | | [Pubmed] | [DOI] | | | 85 |
Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications |
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| Joseph A. Giovannitti,Sean M. Thoms,James J. Crawford | | Anesthesia Progress. 2015; 62(1): 31 | | [Pubmed] | [DOI] | | | 86 |
Comparison of clonidine and dexmedetomidine as adjuncts to intravenous regional anaesthesia |
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| ShaliniPravin Sardesai, KalyaniNilesh Patil, Adnanali Sarkar | | Indian Journal of Anaesthesia. 2015; 59(11): 733 | | [Pubmed] | [DOI] | | | 87 |
Postoperative Analgesia in Morbid Obesity |
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| Adrian Alvarez,Preet Mohinder Singh,Ashish C. Sinha | | Obesity Surgery. 2014; 24(4): 652 | | [Pubmed] | [DOI] | | | 88 |
Dexmedetomidine preconditioning ameliorates kidney ischemia-reperfusion injury |
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| Juha Lempiäinen,Piet Finckenberg,Elina E. Mervaala,Markus Storvik,Juha Kaivola,Ken Lindstedt,Jouko Levijoki,Eero M. Mervaala | | Pharmacology Research & Perspectives. 2014; 2(3): n/a | | [Pubmed] | [DOI] | | | 89 |
Dexmedetomidine: Expanding role in anesthesia |
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| JyotsnaS Paranjpe | | Medical Journal of Dr. D.Y. Patil University. 2013; 6(1): 5 | | [Pubmed] | [DOI] | |
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