Dexmedetomidine Use in General Anaesthesia

Institute of Anesthesia and Intensive Care, Catholic University of Rome, Italy.
Current drug targets (Impact Factor: 3.02). 09/2009; 10(8):687-95. DOI: 10.2174/138945009788982423
Source: PubMed


Dexmedetomidine is a potent and highly selective alpha(2)-adrenoreceptor agonist currently utilized for continuous infusion for sedation/analgesia in the intensive care unit (ICU). Dexmedetomidine offers remarkable pharmacological properties including sedation, anxiolysis, and analgesia with the unique characteristic to cause no respiratory depression. In addition it posses sympatholytic and antinociceptive effects that allow hemodynamic stability during surgical stimulation. Different from most of clinically used anesthetics, dexmedetomidine brings about not only a sedative-hypnotic effect via an action on a single type of receptors, but also an analgesic effect and an autonomic blockade that is beneficial in cardiac risk situations. Several studies have demonstrated its safety, although bradycardia and hypotension are the most predictable and frequent side effects. Dexmedetomidine has shown to consistently reduce opioids, propofol, and benzodiazepines requirements. In the last years it has emerged as an affective therapeutic drug in a wide range of anesthetic management, promising large benefits in the perioperative use. In particular this review focuses on dexmedetomidine utilization in premedication, general surgery, neurosurgery, cardiac surgery, bariatric surgery, and for procedural sedation and awake fiberoptic intubation. In all these fields dexmedetomidine has demonstrated to be an efficacious and safe adjuvant to other sedative and anesthetic medications.

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    • "Physiological responses to endogenous catecholamines epinephrine (adrenaline) and norepinephrine (noradrenaline) are mediated by three ␣ 2 -AR subtypes: ␣ 2A , ␣ 2B and ␣ 2C (Bylund, 1992, 2005; Hieble et al., 1995; Docherty, 1998; Calzada and Artinano, 2001). Being involved in many diverse cellular functions and physiological processes, these receptors are considered as important drug targets in the treatment of elevated blood pressure, pain, opioid and alcohol withdrawal symptoms, in anesthetic care and also for treatment of glaucoma, spasticity, depression, attentiondeficit/hyperactivity disorder, obesity and diabetes (Serle et al., 1991; Ruffolo et al., 1993, 1995; Ruffolo and Hieble, 1994; Lakhlani et al., 1997; Arnsten, 1998; Kable et al., 2000; Crassous et al., 2007; Sanders and Maze, 2007; Arcangeli et al., 2009; Cinnamon Bidwell et al., 2010; Cottingham et al., 2011). However, currently available drugs acting at the ␣ 2 -AR show only marginal subtype selectivity, and consequently possess several unwanted side-effects (e.g. "
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    ABSTRACT: Although G protein-coupled receptors (GPCRs) are traditionally categorized as Gs-, Gq-, or Gi/o-coupled, their signaling is regulated by multiple mechanisms. GPCRs can couple to several effector pathways, having the capacity to interact not only with more than one G protein subtype but also with alternative signaling or effector proteins such as arrestins. Moreover, GPCR ligands can have different efficacies for activating these signaling pathways, a characteristic referred to as biased agonism or functional selectivity.
    Brain Research Bulletin 08/2014; 107. DOI:10.1016/j.brainresbull.2014.07.005 · 2.72 Impact Factor
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    • "Stimulation of α2-adrenoreceptor subtypes mediates sedative and antinociceptive actions (α2A) and a vasoconstrictive cardiovascular effect (α2B), and modulates dopaminergic neurotransmission, hypothermia and a variety of behavioral responses (α2C) [12]. The inhibition of norepinephrine release suppresses the level of excitation, especially in the locus coeruleus (α2A) which controls anxiety, arousal, sleep, and opioid withdrawal [12]. "
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    ABSTRACT: Dexmedetomidine is an α2-adrenoreceptor agonist with sedative, analgesic and anxiolytic effects, and it has more selective α2-adrenergic effect than clonidine. We evaluate the effect of preansethetic dexmedetomidine 1 µg/kg single infusion on sedation, hemodynamics, anesthetic consumption, and recovery profiles during anesthesia. Forty-two female patients with American Society of Anesthesiologists physical status I or II undergoing gynecologic surgery with anticipated operation time of 2 h, were randomly assigned to receive dexmedetomidine 1 µg/kg (Dex group) or saline (control group) iv over 10 min before anesthetic induction. After tracheal intubation with propofol 2 mg/kg, cisatracurium 0.15 mg/kg iv, anesthesia was maintained with sevoflurane, O2 50%, N2O 50% around a BIS value of 40. After study drug infusion, BIS of Dex group was lower than that of control group (93.9 ± 3.1 vs 51.5 ± 5.2, P < 0.05). Mean arterial pressure (MAP) and heart rate (HR) after intubation were increased in control group, but did not change in Dex group. During maintenance, there was no difference in MAP between groups, but HR of Dex group was lower compared to that of control group. End-tidal concentration (2.0 ± 0.5 vol% vs 1.4 ± 0.3 vol%, P < 0.05) and total cumulative consumption of sevoflurane (34.6 ± 3.8 ml vs 26.5 ± 5.3 ml, P < 0.05) were lower in Dex group than in control group. Recovery profiles, modified Aldrete score, postoperative nausea vomiting, and visual analogue pain score were not significantly different between groups. Preanesthetic dexmetomidine 1 µg/kg single infusion is a simple, easy, and economic general anesthetic adjuvant that maintains stable hemodynamics and decrease anesthetic consumption without the change of recovery profiles.
    Korean journal of anesthesiology 08/2013; 65(2):114-20. DOI:10.4097/kjae.2013.65.2.114
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    • "Hypotension and bradycardia are common adverse hemodynamic effects in patients receiving dexmedetomidine as a result of decreasing the central sympathetic nervous activity or preserving the baroreceptor reflex [7]. In the present study, only a few patients had significant hypotension and bradycardia during or after dexmedetomidine administration and responded well to rescue medications. "
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    ABSTRACT: The purpose of this study was to determine the effect of dexmedetomidine on hemodynamic responses to DLT intubation compared to placebo and to assess the adverse effects related to dexmedetomidine. Sixty patients were randomly allocated to receive 0.7 μ g/kg dexmedetomidine (n = 30) or normal saline (n = 30) 10 minutes before general anesthesia. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) between groups were recorded. During intubation and 10 minutes afterward (T1-T10), the mean SBP, DBP, MAP, HR, and RPP in the control group were significantly higher than those in the dexmedetomidine group throughout the study period except at T1. The mean differences of SBP, DBP, MAP, HR, and RPP were significantly higher in the control group, with the value of 15.2 mmHg, 10.5 mmHg, 14 mmHg, 10.5 beats per minute, and 2,462.8 mmHg min(-1). Four patients in the dexmedetomidine group and 1 patient in the control group developed hypotension, while 2 patients in the dexmedetomidine group had bradycardia. Prophylactic dexmedetomidine can attenuate the hemodynamic responses to laryngoscopy and DLT intubation with minimal adverse effects. This trial is registered with NCT01289769.
    Anesthesiology Research and Practice 07/2013; 2013:236089. DOI:10.1155/2013/236089
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