Korean J Anesthesiol.  2012 May;62(5):405-411. 10.4097/kjae.2012.62.5.405.

Dexmedetomidine sedation in ICU

• Yu SB

• KMID: 2243817
• DOI: http://doi.org/10.4097/kjae.2012.62.5.405

Abstract

Dexmedetomidine (DEX), a highly selective alpha2-adrenergic receptor agonist, is the newest agent introduced for sedation in intensive care unit (ICU). The sedation strategy for critically ill patients has stressed light sedation with daily awakening and assessment for neurologic, cognitive, and respiratory functions, since Society of Critical Care Medicine (SCCM) guidelines were presented in 2002. The traditional GABAergic agents, including benzodiazepines and propofol, have some limitations for safe sedatives in this setting, due to an unfavorable pharmacokinetic profile and to detrimental adverse effects (such as lorazepam associated propylene glycol intoxication and propofol infusion syndrome). DEX produces it's sedative, analgesic and cardiovascular effects through alpha2 receptors on the locus ceruleus (LC). Activities of LC, the tuberomammillary nucleus (TMN) are depressed and activity of the ventrolateral preoptic nucleus (VLPO) is increased during DEX sedation, which is similar in features to normal non-REM (NREM) sleep. At the same time, perifornical orexinergic activity is maintained, which might be associated with attention. This mechanism of action produces a normal sleep-like, cooperative sedation. The characteristic feature of sedation, together with a concomitant opioid sparing effect, may decrease the length of time spent on a ventilator, length of stay in ICU, and prevalence and duration of delirium, as the evidence shown from several comparative studies. In addition, DEX has an excellent safety profile. In conclusion, DEX is considered as a promising agent optimized for sedation in ICU.

Keyword

Dexmedetomidine; Delirium; ICU; Sedation; Sleep

MeSH Terms

Alkenes
Benzodiazepines
Critical Care
Critical Illness
Delirium
Dexmedetomidine
GABA Agents
Humans
Hypnotics and Sedatives
Hypothalamic Area, Lateral
Intensive Care Units
Length of Stay
Light
Locus Coeruleus
Lorazepam
Prevalence
Propofol
Propylene Glycol
Ventilators, Mechanical
Alkenes
Benzodiazepines
Dexmedetomidine
GABA Agents
Hypnotics and Sedatives
Lorazepam
Propofol
Propylene Glycol