Dexmedetomidine in anaesthesia

Current Opinion in Anaesthesiology

Volumn 18, Issue 4, 2005, Pages 412-418

  Paris, Andrea ^a   Tonner, Peter H ^a  

^a UNIVERSITY HOSPITAL SCHLESWIG HOLSTEIN   (Germany)

Author keywords

Adrenergic receptors; Anaesthesia; Dexmedetomidine; Perioperative use; Sedation; 2 adrenoceptors

Indexed keywords

ALPHA 2 ADRENERGIC RECEPTOR STIMULATING AGENT; ALPHA 2A ADRENERGIC RECEPTOR; ALPHA 2B ADRENERGIC RECEPTOR; ALPHA 2C ADRENERGIC RECEPTOR; CATECHOLAMINE; CLONIDINE; DEXMEDETOMIDINE; IMIDAZOLINE DERIVATIVE; LIDOCAINE; NORADRENALIN; OPIATE; REMIFENTANIL;

ADRENERGIC ACTIVITY; ANALGESIA; ANESTHESIA; ASYSTOLE; BRADYCARDIA; BRAIN ISCHEMIA; CLINICAL TRIAL; DRUG EFFICACY; DRUG MECHANISM; DRUG POTENCY; DRUG POTENTIATION; HEART ARREST; HEART HEMODYNAMICS; HEART MUSCLE ISCHEMIA; HUMAN; HYPOTENSION; INTENSIVE CARE UNIT; META ANALYSIS; NEUROPROTECTION; NEUROTRANSMISSION; NONHUMAN; PAIN; PERIOPERATIVE PERIOD; POSTOPERATIVE ANALGESIA; PRIORITY JOURNAL; RESPIRATION DEPRESSION; REVIEW; SEDATION; SIDE EFFECT; SINUS ARREST; TRANQUILIZING ACTIVITY; UNITED STATES; VASOCONSTRICTION;

EID: 23044490751     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.aco.0000174958.05383.d5     Document Type: Review

References (89)

1. Stähle H. Clonidine. In: Bindra JS, Lednicer D, editors. Chronicles of drug discovery, vol. 1. New York: John Wiley and Sons; 1982. pp. 87-111.
2. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59: 263-70.
3. Karol MD, Maze M. Pharmacokinetics and interaction pharmacodynamics of dexmedetomidine in humans. In: Van Aken, H., editor. Balliere's clinical anaesthesiology, vol. 14, no. 2. London: Balliere Tindall (a Harcourt Health Sciences company); 2000. pp. 261-269.
4. Scholz J, Tonner PH. α2-Adrenoceptor agonists in anaesthesia: a new paradigm. Curr Opin Anaesthesiol 2000; 13:437-442.
5. Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology 2000; 93:1345-1349.
6. R. Dexmedetomidine hydrochloride injection prescribing information. Abbott Laboratories, USA; 2004.
7. Philipp M, Hein L. Adrenergic receptor knockout mice: distinct functions of 9 receptor subtypes. Pharmacol Ther 2004; 101:65-74. An interesting review discussing the findings in gene-targeted mice about the distinct functions of the nine adrenergic receptor subtypes and subtype-specific drug therapy.
8. Rockman HA, Koch WJ, Lefkowitz RJ. Seven-transmembrane-spanning receptors and heart function. Nature 2002; 415:206-212.
9. Philipp M, Brede M, Hein L. Physiological significance of alpha2-adrenergic receptor subtype diversity: one receptor is not enough. Am J Physiol Regul Integr Comp Physiol 2002; 283:R287-R295.
10. Bylund DB, Eikenburg DC, Hieble JP, et al. International Union of Pharmacology nomenclature of adrenoceptors. Pharmacol Rev 1994; 46:121-136.
11. Kobilka BK, Matsui H, Kobilka TS, et al. Cloning, sequencing, and expression of the gene coding for the human platelet alpha2-adrenergic receptor. Science (Washington DC) 1987; 238:650-656.
12. Lomasney JW, Lorenz W, Allen LF, et al. Expansion of the alpha2-adrenergic receptor family: cloning and characterization of a human alpha2-adrenergic receptor subtype, the gene for which is located on chromosome 2. Proc Natl Acad Sci U S A 1990; 87:5094-5098.
13. Regan JW, Kobilka TS, Yang FT, et al. Cloning and expression of a human kidney cDNA for an alpha2-adrenergic receptor subtype. Proc Natl Acad Sci U S A 1998; 85:6301-6305.
14. 2- adrenoceptor stimulation.
15. Hein L, Limbird LE, Eglen RM, Kobilka BK. Gene substitution/knockout to delineate the role of alpha2-adrenoceptor subtypes in mediating central effects of catecholamines and imidazolines. Ann NY Acad Sci 1999; 881:265-271.
16. Hein L. Transgenic models of alpha 2-adrenergic receptor subtype function. Rev Physiol Biochem Pharmacol 2001; 142:161-185.
17. Bylund DB. Pharmacological characteristics of alpha-2 adrenergic receptor subtypes. Ann NY Acad Sci 1995; 763:1-7.
18. MacMillan LB, Hein L, Smith MS, et al. Central hypotensive effects of the alpha2a-adrenergic receptor subtype. Science 1996; 273:801-803.
19. Hunter JC, Fontana DJ, Hedley LR, et al. Assessment of the role of alpha2-adrenoceptor subtypes in the antinociceptive, sedative and hypothermic action of dexmedetomidine in transgenic mice. Br J Pharmacol 1997; 122:1339-1344.
20. Lakhlani PP, MacMillan LB, Guo TZ, et al. Substitution of a mutant alpha2a-adrenergic receptor via "hit and run" gene targeting reveals the role of this subtype in sedative, analgesic, and anesthetic-sparing responses in vivo. Proc Natl Acad Sci U S A 1997; 94:9950-9955.
21. Lahdesmaki J, Sallinen J, MacDonald E, et al. Behavioral and neurochemical characterization of alpha(2A)-adrenergic receptor knockout mice. Neuroscience 2002; 113:289-299.
22. Ihalainen JA, Tanila H. In vivo regulation of dopamine and noradrenaline release by alpha2A-adrenoceptors in the mouse nucleus accumbens. J Neurochem 2004; 91:49-56.
23. Link RE, Desai K, Hein L, et al. Cardiovascular regulation in mice lacking alpha2-adrenergic receptor subtypes b and c. Science 1996; 273:803-805.
24. Makaritsis KP, Handy DE, Johns C, et al. Role of the alpha2B-adrenergic receptor in the development of salt-induced hypertension. Hypertension 1999; 33:14-17.
25. Guo TZ, Poree L, Golden W, et al. Antinociceptive response to nitrous oxide is mediated by supraspinal opiate and spinal alpha 2 adrenergic receptors in the rat. Anesthesiology 1996; 85:846-852.
26. Sawamura S, Kingery WS, Davies MF, et al. Antinociceptive action of nitrous oxide is mediated by stimulation of noradrenergic neurons in the brainstem and activation of [alpha]2B adrenoceptors. J Neurosci 2000; 20:9242-9251.
27. Dawson C, Ma D, Chow A, Maze M. Dexmedetomidine enhances analgesic action of nitrous oxide: mechanisms of action. Anesthesiology 2004; 100:894-904. This paper investigates the analgesic interaction of dexmedetomidine and nitrous oxide, and discusses the possible clinical applications.
28. Takada K, Clark DJ, Davies MF, et al. Meperidine exerts agonist activity at the alpha(2B)-adrenoceptor subtype. Anesthesiology 2002; 96:1420-1426.
29. Paris A, Ohlendorf C, Marquardt M, et al. Effect of meperidine on thermoregulation in mice: involvement of alpha2-adrenoceptors. Anesth Analg 2005; 100:102-106.
30. Sallinen J, Link RE, Haapalinna A, et al. Genetic alteration of alpha 2C-adrenoceptor expression in mice: influence on locomotor, hypothermic, and neurochemical effects of dexmedetomidine, a subtype-nonselective alpha 2-adrenoceptor agonist. Mol Pharmacol 1997; 51:36-46.
31. Scheinin M, Sallinen J, Haapalinna A. Evaluation of the alpha2C-adrenoceptor as a neuropsychiatric drug target studies in transgenic mouse models. Life Sci 2001; 68:2277-2285.
32. Fairbanks CA, Stone LS, Kitto KF, et al. Alpha(2C)-adrenergic receptors mediate spinal analgesia and adrenergic-opioid synergy. J Pharmacol Exp Ther 2002; 300:282-290.
33. Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anaesthesia 1999; 54: 146-165.
34. Paris A, Philipp M, Tonner PH, et al. Activation of alpha 2B-adrenoceptors mediates the cardiovascular effects of etomidate. Anesthesiology 2003; 99:889-895.
35. Penttila J, Helminen A, Anttila M, et al. Cardiovascular and parasympathetic effects of dexmedetomidine in healthy subjects. Can J Physiol Pharmacol 2004; 82:359-362.
36. Talke P, Li J, Jain U, et al. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. The Study of Perioperative Ischemia Research Group. Anesthesiology 1995; 82:620-633.
37. Jalonen J, Hynynen M, Kuitunen A, et al. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 1997; 86:331-345.
38. Khan ZP, Munday IT, Jones RM, et al. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers 1. Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth 1999; 83:372-380.
39. Shehabi Y, Ruettimann U, Adamson H, et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intens Care Med 2004; 30:2188-2196.
40. Ingersoll-Weng E, Manecke GR Jr, Thistlethwaite PA. Dexmedetomidine and cardiac arrest. Anesthesiology 2004; 100:738-739. An interesting case report to increase one's awareness of possible side-effects.
41. Videira RL, Ferreira RM. Dexmedetomidine and asystole. Anesthesiology 2004; 101:1479.
42. Jorden VS, Pousman RM, Sanford MM, et al. Dexmedetomidine overdose in the perioperative setting. Ann Pharmacother 2004; 38:803-807.
43. Ramsay MA, Luterman DL. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology 2004; 101:787-790. An elegant discussion on the basis of case reports showing the profound sedative properties of dexmedetomidine able to induce general anaesthesia.
44. Ickeringill M, Shehabi Y, Adamson H, Ruettimann U. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy. Anaesth Intens Care 2004; 32:741-745.
45. 2-adrenoceptor agonist clonidine reduced the incidence of postoperative mortality for up to 2 years.
46. Stuhmeier KD, Mainzer B, Cierpka J, et al. Small, oral dose of clonidine reduces the incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology 1996; 85:706-712.
47. Oliver MF, Goldman L, Julian DG, Holme I. Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary heart disease: the European Mivazerol Trial (EMIT). Anesthesiology 1999; 91:951-961.
48. Nishina K, Mikawa K, Uesugi T, et al. Efficacy of clonidine for prevention of perioperative myocardial ischemia. Anesthesiology 2002; 96:323-329.
49. Jalonen J, Halkola L, Kuttila K, et al. Effects of dexmedetomidine on coronary hemodynamics and myocardial oxygen balance. J Cardiothorac Vasc Anesth 1995; 9:519-524.
50. Ebert TJ, Hall JE, Barney JA, et al. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93: 382-394.
51. Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54:1136-1142.
52. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care 2000; 4:302-308.
53. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology 1992; 77:1125-1133.
54. Hsu YW, Cortinez LI, Robertson KM, et al. Dexmedetomidine pharmacodynamics. Part I. Crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101: 1066-1076. This paper underlines the respiratory safety of dexmedetomidine in healthy volunteers.
55. Nelson LE, Lu J, Guo T, et al. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98:428-436.
56. Maze M, Angst MS. Dexmedetomidine and opioid interactions: defining the role of dexmedetomidine for intensive care unit sedation. Anesthesiology 2004; 101:1059-1061.
57. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342:1471-1477.
58. Eisenach J, Detweiler D, Hood D. Hemodynamic and analgesic actions of epidurally administered clonidine. Anesthesiology 1993; 78:277-287.
59. Tryba M, Gehling M. Clonidine - a potent analgesic adjuvant. Curr Opin Anaesthesiol 2002; 15:511-517.
60. Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984-1995) Anesthesiology 1996; 85:655-674.
61. Memis D, Turan A, Karamanlioglu B, et al. Adding dexmedetomidine to lidocaine for intravenous regional anesthesia. Anesth Analg 2004; 98: 835-840.
62. Cortinez LI, Hsu YW, Sum-Ping ST, et al. Dexmedetomidine pharmacodynamics. Part II. Crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 2004; 101:1077-1083.
63. Angst MS, Ramaswamy B, Davies MF, Maze M. Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans. Anesthesiology 2004; 101:744-752. A well-conducted experimental pain model investigating the analgesic properties of systemically administered dexmedetomidine.
64. Kauppila T, Kemppainen P, Tanila H, Pertovaara A. Effect of systemic medetomidine, an alpha 2 adrenoceptor agonist, on experimental pain in humans. Anesthesiology 1991; 74:3-8.
65. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004; 98:153-158. An interesting study underlining the opioid-sparing properties of a postoperative infusion of dexmedetomidine.
66. Kuhmonen J, Pokorny J, Miettinen R, et al. Neuroprotective effects of dexmedetomidine in the gerbil hippocampus after transient global ischemia. Anesthesiology 1997; 87:371-377.
67. Jolkkonen J, Puurunen K, Koistinaho J, et al. Neuroprotection by the alpha2-adrenoceptor agonist, dexmedetomidine, in rat focal cerebral ischemia. Eur J Pharmacol 1999; 372:31-36.
68. Maier C, Steinberg GK, Sun GH, et al. Neuroprotection by the alpha 2-adrenoreceptor agonist dexmedetomidine in a focal model of cerebral ischemia. Anesthesiology 1993; 79:306-312.
69. Ma D, Hossain M, Rajakumaraswamy N, et al. Dexmedetomidine produces its neuroprotective effect via the alpha2A-adrenoceptor subtype. Eur J Pharmacol 2004; 502:87-97.
70. Laudenbach V, Mantz J, Lagercrantz H, et al. Effects of alpha(2)-adrenoceptor agonists on perinatal excitotoxic brain injury: comparison of clonidine and dexmedetomidine. Anesthesiology 2002; 96:134-141.
71. Hoffman WE, Kochs E, Werner C, et al. Dexmedetomidine improves neurologic outcome from incomplete ischemia in the rat. Reversal by the alpha 2-adrenergic antagonist atipamezole. Anesthesiology 1991; 75:328-332.
72. Hoffman WE, Cheng MA, Thomas C, et al. Clonidine decreases plasma catecholamines and improves outcome from incomplete ischemia in the rat. Anesth Analg 1991; 73:460-464.
73. Altman JD, Trendelenburg AU, MacMillan L, et al. Abnormal regulation of the sympathetic nervous system in alpha2A-adrenergic receptor knockout mice. Mol Pharmacol 1999; 56:154-161.
74. Ruffolo RR, Nichols AJ, Stadel JM, Hieble JP. Structure and function of alpha2-adrenocepors. Pharmacol Rev 1991; 43:475-501.
75. Ebert T, Maze M. Dexmedetomidine: another arrow for the clinician's quiver. Anesthesiology 2004; 101:568-570. An excellent editorial accompanying case reports of dexmedetomidine administered as a total intravenous agent.
76. Grant SA, Breslin DS, MacLeod DB, et al. Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases. J Clin Anesth 2004; 16:124-126. This paper discusses the anaesthetic management and implications of using dexmedetomidine for fibreoptic intubation.
77. Kulkarni A, Price G, Saxena M, Skowronski G. Difficult extubation: calming the sympathetic storm. Anaesth Intens Care 2004; 32:413-416.
78. Maccioli GA. Dexmedetomidine to facilitate drug withdrawal. Anesthesiology 2003; 98:575-577.
79. Multz AS. Prolonged dexmedetomidine infusion as an adjunct in treating sedation-induced withdrawal. Anesth Analg 2003; 96:1054-1055.
80. Finkel JC, Elrefai A. The use of dexmedetomidine to facilitate opioid and benzodiazepine detoxification in an infant. Anesth Analg 2004; 98:1658-1659.
81. Ard JL Jr, Bekker AY, Doyle WK. Dexmedetomidine in awake craniotomy: a technical note. Surg Neurol 2005; 63:114-116.
82. Ard J, Doyle W, Bekker A. Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol 2003; 15:263-266.
83. Bekker AY, Kaufman B, Samir H, Doyle W. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg 2001; 92:1251-1253.
84. Mack PF, Perrine K, Kobylarz E, et al. Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol 2004; 16:20-25.
85. Bekker AY, Basile J, Gold M, et al. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol 2004; 16:126-135. This paper outlines an innovative use of dexmedetomidine as a primary sedative for awake carotid endarterectomy combined with regional anaesthesia, allowing neurological evaluation of the patients.
86. Ibacache ME, Munoz HR, Brandes V, Morales AL. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg 2004; 98:60-63.
87. Serlin S. Dexmedetomidine in pediatrics: controlled studies needed. Anesth Analg 2004; 98:1814.
88. Tobias JD, Berkenbosch JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J 2004; 97:451-455.
89. Tobias JD, Berkenbosch JW, Russo P. Additional experience with dexmedetomidine in pediatric patients. South Med J 2003; 96:871-875.