An Updated Focused Review of Dexmedetomidine in Adults

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 a published since our previous review in 2007 to the present. MeSH terms included dexmedetomidine, medetomidine, alpha(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 alpha(2)-agonist used for sedation during and in critical illness. Compared with placebo, use of dexmedetomidine during procedures was associated with decreased use of rescue midazolan 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 mu g/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 an alternative for procedural sedation and can be used long-term (>24 h) in critically ill patients, in dosages up to 1.5 mu g/kg/hour. More studies are needed to better define the role of dexmedetomidine in preventing and treating delirium.