Dexmedetomidine
-Dexmedetomidine is a highly selective alpha-2 adrenergic agonist used as a sedative and analgesic agent. It acts centrally to produce sedation and analgesia without causing significant respiratory depression. -Dexmedetomidine is an anxiolytic, sedative, and pain medication. It has ability to provide sedation without risk of respiratory depression and can provide cooperative or semirousable sedation. It is a sympatholytic drug that acts as an agonist of ?2-adrenergic receptors in certain parts of the brain.-Sedation of mechanically ventilated patients in the intensive care unit (ICU). -Procedural sedation in non-intubated patients, such as during surgery or diagnostic procedures. -Intensive Care Unit Sedation -Dexmedetomidine is indicated for sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting. It should be administered by continuous infusion not to exceed 24 hours. -Dexmedetomidine has been continuously infused in mechanically ventilated patients prior to extubation, during extubation, and post-extubation. It is not necessary to discontinue it prior to extubation. -Procedural Sedation It is indicated for sedation of non-intubated patients prior to and/or during surgical and other procedures.
-The dosage of dexmedetomidine is individualized based on the patient's age, weight, and clinical condition. It is typically administered as a continuous intravenous infusion. -Usual Adult Dose for Sedation: Intensive Care Unit Sedation: -Initial Dose: Loading dose of 1 mcg/kg IV infusion over 10 minutes. -Maintenance Dose: 0.2 to 0.7 mcg/kg/hour IV infusion; adjust the infusion rate to achieve the desired clinical effect. Procedural Sedation: -Initial Dose (including Awake Fiberoptic Intubation): 1 mcg/kg IV infusion over 10 minutes. -Maintenance Dose: Initiate IV infusion at 0.6 mcg/kg/hour and titrate to achieve the desired clinical effect; doses may range from 0.2 to 1 mcg/kg/hour. Uses: Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; sedation of non-intubated patients prior to and/or during surgical and other procedures. Usual Geriatric Dose for Sedation: Over Age 65 Years: Intensive Care Unit Sedation: Dose reduction may be required; however, no specific guidelines have been suggested. Procedural Sedation: -Initial Dose (including Awake Fiberoptic Intubation): 1 mcg/kg IV infusion over 10 minutes. -Maintenance Dose: Initiate IV infusion at 0.6 mcg/kg/hour and titrate to achieve the desired clinical effect; doses may range from 0.2 to 1 mcg/kg/hour. Uses: Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; sedation of non-intubated patients prior to and/or during surgical and other procedures. Usual Geriatric Dose for Sedation: Over Age 65 Years: Intensive Care Unit Sedation: Dose reduction may be required; however, no specific guidelines have been suggested. Procedural Sedation: -Initial Dose: May be omitted or reduced (e.g., 0.5 mcg/kg IV infusion over 10 minutes). -Maintenance Dose: Dose reduction may be required; however, no specific guidelines have been suggested. Uses: Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; sedation of non-intubated patients prior to and/or during surgical and other procedures.
-Hypersensitivity to dexmedetomidine. -Severe heart block. -Recent use of monoamine oxidase inhibitors (MAOIs).
-Caution in patients with cardiovascular disease, as dexmedetomidine can cause bradycardia and hypotension. -Monitoring of blood pressure, heart rate, and oxygen saturation is essential during administration. -Use with caution in elderly patients and those with hepatic or renal impairment. Paediatric: Safety and efficacy in pediatric patients have not been established. Pregnancy: Category C; It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Lactation: it is not known whether it is excreted into the breast milk. Elderly: dose reduction may be considered in patients over 65 years of age.
-Bradycardia. -Hypotension. -Nausea and vomiting. -Dry mouth. -Shivering. -Dizziness. -Short-term (<24 hours) infusions for ICU sedation: Hypotension, hypertension, nausea, bradycardia, fever, vomiting, hypovolemia, atelectasis, atrial fibrillation, hypoxia, tachycardia, hemorrhage, anemia, dry mouth. Long-term (>24 hours) infusions for ICU sedation: Hypotension, bradycardia, hypertension, tachycardia, hypokalemia, agitation, hyperglycemia, constipation, hypoglycemia, respiratory failure. Procedural sedation: Hypotension, respiratory depression, bradycardia, hypertension, tachycardia, nausea, dry mouth.
-Concurrent use with other sedatives or opioids may enhance central nervous system depression. -Sympathomimetic drugs may counteract the effects of dexmedetomidine. -Coadministration with antihypertensive medications may lead to additive hypotensive effects.
