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  • ISSN: 2333-6641
    Volume 5, Issue 4
    Brief Communication
    Sonia Maria Veiras del Rio*
    Patients admitted in ICUs do frequently need from sedation to mitigate uncomfortable or painful maneuvres. Tracheal intubation, mobilization of the patient for grooming or wound dressing review are some examples of unpleasant experiences.
    Besides, some patients are quiet and collaborator even during intubation and mechanical ventilation, but it is not infrequent to find psychomotor agitation during ICU admission, so that the physician and the nurses find severe difficulties to manage the normal evolution of respiratory weaning and rehabilitation processes are impaired.
    We need the patients to be calm and quiet, but at the same time, alert and cooperative, and its difficult to reach this balance.
    Case Series
    Deborah A. Sciandra*, Prashant Joshi, and Christopher Heard
    Background: In the PICU many patients require prolonged sedation with opioids and benzodiazepines. Tolerance to those agents is often problematic. Many of these patients also require adjunct paralysis. Dexmedetomidine is a new sedative agent that may prove useful for these patients.
    Objective: Evaluate the effectiveness of Dexmedetomidine on our difficult to sedate PICU patients.
    Methods: We performed a retrospective chart review on patients that had received Dexmedetomidine in our PICU. We evaluated the effects of sedative dosing for those patients and any changes in doses that occured. Side effects were also evaluated.
    Results: We found a decreased sedative dose requirement, and less use of muscle relaxants. Also noted was a decreased methadone requirement in those patients that received Dexmedetomidine. Side effects were minimal.
    Conclusion: The use of dexmedetomidine seemed to be helpful in managing patients in our PICU that were difficult to sedate. Further analysis of Dexmedetomidine use in other patients, as well as cost analysis would be useful.
    Short Note
    Scrollavezza Paolo*
    A variety of alpha2 adrenoceptor agonists - xylazine, detomidine, romifidine, medetomidine (MED) and dexmedetomidine (DEX) - have been developed in veterinary medicine for sedative purpose.
    Review Article
    Uma Hariharan* and Vinoth Natarajan
    The use of alpha-2 agonists in anesthesia practice is not new and had been started in the late twentieth century. Clonidine, the prototype of alpha-2 agonist, is widely used as an adjunct in anaesthesia and pain medicine. Dexmedetomidine is the next generation alpha-2 agonist with high selectivity for alpha-2 receptors (1600:1). This agent is 10 times more potent than clonidine and associated with fewer hemodynamic and systemic side effects. In addition, it has a reversible drug for its sedative property. More than 1000 clinical trials and studies have been published regarding the use of dexmedetomidine in humans with reasonable results. This article aims to illustrate the various modes and utilities of dexmedetomidine with its appropriate dosage in the field of anesthesiology, pain and perioperative medicine.
    Pierre S. Chue* and James A. Chue
    Dexmedetomidine is highly selective α2A - adrenergic receptor agonist approved for short-term sedation in an intensive care unit (ICU) setting or in non-intubated patients prior to and/or during surgical and other procedures. Dexmedetomidine is the dextro isomer of medetomidine with eight times greater selectivity for α2-adrenergic receptors than clonidine. This action in the central and peripheral nervous systems results in sedation and analgesia (sedoanalgesia). Dexmedetomidine is devoid of opioid and gabaergic activity and is not associated with respiratory depression resulting in cooperative and conscious (semi-arousable) sedation. The inhibition of sympathetic stress response mediated via α2 - adrenergic receptor reduces heart rate and blood pressure, which promotes cardiovascular stability and protection. When given by continuous intravenous infusion it has a rapid onset and a relatively short duration of action (offset is secondary to infusion duration). Dexmedetomidine has been associated with decreased ICU costs in adult patients due to reduced time on mechanical ventilation and length of stay. The lack of respiratory depression allows for rapid extubation despite sedative therapeutic plasma concentrations. Dexmedetomidine possesses some analgesic activity; other applications include as a premedication, in the prevention of emergence delirium or agitation, and for the control of shivering. Use of dexmedetomidine is associated with reduced requirements for analgesics, sedatives and general anesthetics. There are no significant drug-drug interactions due to protein binding or metabolism. Biotransformation is almost complete to inactive metabolites. Dexmedetomidine has been reported to cause higher rates of bradycardia and hypotension, but a lower incidence of neurocognitive dysfunction including delirium. Inhibition of inflammation and activation of protective signaling pathways suggest a possible neuro protective effect. Dexmedetomidine has a very low incidence of withdrawal effects, even after prolonged use. Intranasal, buccal and oral formulations have been developed. Dexmedetomidine is not known as a substance of abuse and it is not a controlled substance.
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