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Specialty Practice Pharmacist, The Ohio State University Medical Center; Clinical Assistant Professor, The Ohio State University, Columbus, OH
Specialty Practice Pharmacist, The Ohio State University Medical Center
Professor Emeritus, The Ohio State University; Adjunct Professor, University of Texas at Austin, Austin, TX
Reprints: Dr. Gerlach, 410 W. 10th Ave., Rm. 368, Doan Hall, Columbus, OH 43210, fax 614/293-3165, Gerlach.6{at}osu.edu
OBJECTIVE: To evaluate recent comparative studies regarding the safety and efficacy of dexmedetomidine in adults.
DATA SOURCES: Articles evaluating safety and efficacy of
dexmedetomidine were identified from an English-language MEDLINE search
(1996–July 2009), with a focus on data published since our previous
review in 2007 to the present. MeSH terms included dexmedetomidine,
medetomidine, 
2-agonist, and sedation. References
from selected articles were also reviewed for additional material.
STUDY SELECTION AND DATA EXTRACTION: Experimental and observational English-language studies that focused on the efficacy, safety, and pharmacoeconomics of dexmedetomidine in humans were selected.
DATA SYNTHESIS: Dexmedetomidine is an
2-agonist used for sedation during procedures and in
critical illness. Compared with placebo, use of dexmedetomidine during
procedures was associated with decreased use of rescue midazolam and a similar
degree of sedation compared with various agents used during surgery or for
procedures. Use of long-term (>24 h) dexmedetomidine sedation is comparable
to sedation with benzodiazepines in critically ill patients. In a Phase 4
study, dexmedetomidine was safe in dosages up to 1.4 µg/kg/hour for greater
than 24 hours and did not produce rebound tachycardia or hypertension when
abruptly discontinued. One small randomized controlled trial demonstrated
decreased incidence of delirium, the primary endpoint, with dexmedetomidine
compared with midazolam or propofol for sedation after cardiac valve surgery.
Many, but not all, studies suggest that dexmedetomidine has a promising role
in prevention and treatment of delirium in critically ill patients when
delirium was studied as a secondary endpoint.
CONCLUSIONS: Dexmedetomidine is an alternative for procedural sedation and can be used long-term (>24 h) in critically ill patients, in dosages up to 1.5 µg/kg/hour. More studies are needed to better define the role of dexmedetomidine in preventing and treating delirium.
Key Words: 2-agonist, dexmedetomidine, sedation
Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M310
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