Dexmedetomidine and the Critically Ill

• Dexmedetomidine is a newer sedative agent that is being used with increasing frequency in the critically ill
• A few pieces of information regarding dexmedetomidine:
  • highly selective alpha-2 agonist
  • produces dose-dependent sedation and anxiolysis while maintaining arousability at deep levels of sedation (hypercapnic arousal is preserved)
  • onset of action is approximately 15 minutes with peak concentration achieved in about 1 hour
  • metabolized via the liver
  • no known active or toxic metabolites
  • loading dose of 1 mcg/kg over 10 minutes followed by 0.2 - 0.7 mcg/kg/hr
• Primary side effect is bradycardia at excessive doses
• Cost is an issue when compared to propofol and midazolam

References

Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.