II. Indications
-
Post-Intubation Sedation and Analgesia
- Short-term sedation (<24 hours) in ICU patients on Mechanical Ventilation
- Tachyphylaxis occurs with use >24 hours
- Noninvasive Positive Pressure Ventilation or NIPPV (e.g. BIPAP)
- Dexmedetomidine may help patients tolerate the NIPPV mask
- Other patients requiring sedation
- Alcohol Withdrawal
- Peri-procedure sedation
- Neurocritical care patients
- Tachycardic patients on Vasopressors
III. Contraindications
- Severe Bradycardia
IV. Mechanism
- Selective central alpha-2-adrenergic agonist (similar to Clonidine) with sedative properties
- Lacks the peripheral effects on vascular resistance of Clonidine
- However, sedation effect is maintained
-
Brainstem G-Protein activation inhibits Norepinephrine release
- Decreases sympathetic tone and peripheral vascular resistance
V. Advantages
VI. Pharmacokinetics
- Onset: 10 minutes
- Duration: 1-2 hours
- Renal and hepatic metabolism
VII. Dosing: General
- Load: 1 mcg/kg in adults (0.5 to 1 mcg/kg in children) over 10 minutes, then
- Precaution: Bolus may result in Hypotension
- Infusion: 0.2 to 0.7 mcg/kg/hour in adults (0.2 to 0.5 mcg in children)
- Titrate to desired level of sedation, modifying dose every 30 min to 0.2 to 1.5 mcg/kg/hour
- Decrease dosing in hepatic dysfunction and the elderly
- Reduce dose in over age 65 years or renal/hepatic Impairment
VIII. Dosing: Post-Intubation Sedation
IX. Adverse Effects
- Severe Bradycardia
- If Heart Rate drops below minimum threshold, stop infusion for 30 min, and restart at 1/2 prior rate
-
Hypotension
- Transient Hypertension may occur with rapid infusion or bolus
- Dry Mouth
- Potent Diuretic
X. References
- Swaminathan and Weingart in Herbert (2019) EM:Rap 19(6): 14
- Fisher and Fisher (2018) Crit Dec Emerg Med 32(1): 24
- Kay (2015) Crit Dec Emerg Med 29(8): 11-17
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| Definition (MSH) | A imidazole derivative that is an agonist of ADRENERGIC ALPHA-2 RECEPTORS. It is closely-related to MEDETOMIDINE, which is the racemic form of this compound. |
| Definition (NCI) | An imidazole derivate and active d-isomer of medetomidine with analgesic, anxiolytic and sedative properties. Dexmedetomidine selectively binds to presynaptic alpha-2 adrenoceptors located in the brain, thereby inhibiting the release of norepinephrine from synaptic vesicles. This leads to an inhibition of postsynaptic activation of adrenoceptors, which inhibit sympathetic activity, thereby leading to sedation and anxiolysis. The analgesic effect of this agent is mediated by binding to alpha-2 adrenoceptors in the spinal cord. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D020927 |
| SnomedCT | 438079000, 437750002 |
| English | (+)-4-((S)-alpha,2,3-Trimethylbenzyl)imidazole, 1H-Imidazole, 4-(1-(2,3-dimethylphenyl)ethyl)-, (R)-, Dexmedetomidine (substance), Dexmedetomidine (product), Dexmedetomidine, Dexmedetomidine [Chemical/Ingredient], DEXMEDETOMIDINE, dexmedetomidine |
| Swedish | Dexmedetomidin |
| Czech | dexmedetomidin |
| Finnish | Deksmedetomidiini |
| Russian | DEKSMEDETOMIDIN, ДЕКСМЕДЕТОМИДИН |
| Japanese | プレセデックス, デキサメデトミジン, デキスメデトミジン, デクスメデトミジン塩酸塩, デクスメデトミジン, 塩酸デクスメデトミジン, D-メデトミジン |
| Spanish | dexmedetomidina, Dexmedetomidina, Dexmedetomidina (sustancia), dexmedetomidina (producto) |
| Polish | Deksmedetomidyna |
| French | Dexmédétomidine |
| German | Dexmedetomidin |
| Italian | Dexmedetomidina |
| Portuguese | Dexmedetomidina |
Ontology: Precedex (C0876757)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D020927 |
| English | Hospira Brand of Dexmedetomidine Hydrochloride, Precedex, precedex |
Ontology: Dexdomitor (C2732176)
| Concepts | Organic Chemical (T109) , Pharmacologic Substance (T121) |
| English | Dexdomitor |
