Sedation and analgesia in the intensive care unit: Evaluating the role of dexmedetomidine

American Journal of Health-System Pharmacy

Volumn 64, Issue 1, 2007, Pages 37-44

  Szumita, Paul M ^a   Baroletti, Steven A ^b,c   Anger, Kevin E ^b   Wechsler, Michael E ^b,d  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b BWH   (United States)

^c NORTHEASTERN UNIVERSITY   (United States)

^d HARVARD MEDICAL SCHOOL   (United States)

Author keywords

Anxiolytics, sedatives and hypnotics; Costs; Dexmedetomidine; Drug use; Hospitals; Mechanism of action; Pharmacoeconomics; Toxicity

Indexed keywords

ALFENTANIL; ALPHA ADRENERGIC RECEPTOR STIMULATING AGENT; ANXIOLYTIC AGENT; BENZODIAZEPINE DERIVATIVE; DEXMEDETOMIDINE; FENTANYL; LORAZEPAM; MIDAZOLAM; MORPHINE; MORPHINE SULFATE; NEUROLEPTIC AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; OPIATE; PLACEBO; PROPOFOL;

ANALGESIA; BRADYCARDIA; BRONCHOSPASM; CHEYNE STOKES BREATHING; CLINICAL TRIAL; CONSCIOUSNESS DISORDER; CONSTIPATION; DELIRIUM; DRUG BLOOD LEVEL; DRUG COST; DRUG EFFICACY; DRUG HALF LIFE; DRUG INDUCED DISEASE; DRUG METABOLISM; DRUG PROTEIN BINDING; DRUG USE; EVALUATION; EXTUBATION; FLUSHING; HEART ARRHYTHMIA; HEART ATRIUM FIBRILLATION; HEART FAILURE; HEPATOMEGALY; HOSPITAL DISCHARGE; HUMAN; HYPERKALEMIA; HYPERLIPIDEMIA; HYPERTENSION; HYPOTENSION; INTENSIVE CARE UNIT; LENGTH OF STAY; MEDLINE; METABOLIC ACIDOSIS; MORBIDITY; MORTALITY; PAIN; PRIORITY JOURNAL; PROPOFOL INFUSION SYNDROME; REBOUND HYPEREXCITABILITY; REBOUND HYPERTENSION; RECOMMENDED DRUG DOSE; RESPIRATION DEPRESSION; REVIEW; RHABDOMYOLYSIS; SEDATION; SIDE EFFECT; SYSTEMATIC REVIEW;

EID: 33847337959     PISSN: 10792082     EISSN: None     Source Type: Journal    
DOI: 10.2146/ajhp050508     Document Type: Review

References (49)

1. Tung A, Rosenthal M. Patients requiring sedation. Crit Care Clin. 1995; 11:791-80.
2. Jacobi J, Fraser GL, Coursin DB et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002; 30:119-41.
3. Osterman M, Keenan S, Sieferling R et al. Sedation in the intensive care unit. JAMA. 2000; 283:1451-9.
4. Dasta JF, Kane-Gill SL, Durtschi AJ. Comparing dexmedetomidine prescribing patterns and safety in the naturalistic setting versus published data. Ann Pharmacother. 2004; 38:1130-5.
5. Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000; 59:263-8.
6. Sinclair MD. A review of the physiological effects of alpha2-agonists related to the clinical use of medetomidine in small animal practice. Can Vet J. 2003; 44:885-97.
7. Precedex (dexmedetomidine hydrochloride) injection prescribing information. Lake Forest: IL: Hospira; 2004.
8. Maze M, Scarfini C, Cavaliere F. New agents for sedation in the intensive care unit. Crit Care Clin. 2001; 17:881-97.
9. Baroletti SA, Szumita PM. PIES method of critique. Crit Pathways Cardiol. 2004; 3:205-8.
10. Yaucher NE, Fish JT, Smith HW. Propylene glycol-associated renal toxicity from lorazepam infusion. Pharmacotherapy. 2003; 23:1094-9.
11. Malacrida R, Fritz ME, Suter PM et al. Pharmacokinetics of midazolam administered by continuous intravenous infusion to intensive care patients. Crit Care Med. 1992; 20:1123-6.
12. McKeage K, Perry CM. Propofol: a review of its use in intensive care sedation of adults. CNS Drugs. 2003; 17:235-72.
13. Marik PE. Propofol: an immunomodulating agent. Pharmacotherapy. 2005; 25(5, pt. 2):28S-33S.
14. Devlin JW, Lau AK, Tanios MA. Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors. Pharmacotherapy. 2005; 25:1348-52.
15. Leisure GS, O'Flaherty J, Green L et al. Propofol and postoperative pancreatitis. Anesthesiology. 1996; 84:224-7.
16. Kumar AN, Schwartz DE, Lim KG. Propofol-induced pancreatitis: recurrence of pancreatitis after rechallenge. Chest. 1999; 115:1198-9.
17. Possidente CJ, Rogers FB, Osler TM et al. Elevated pancreatic enzymes after extended propofol therapy. Pharmacotherapy. 1998; 18:653-5.
18. Vasile B, Rasulo F, Candiani A et al. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med. 2003; 29:1417-25.
19. Kang TM. Propofol infusion in critically ill adults. Ann Pharmacother. 2002; 36:1453-6.
20. 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; 54:1136-42.
21. Venn RM, Bryant A, Hall GM et al. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine and inflammatory responses in post-operative patients needing sedation in the intensive care unit. Br J Anaesth. 2001; 86:650-6.
22. Triltsch AE, Weite M, Von Homeyer P et al. Bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study. Crit Care Med. 2002; 30:1007-14.
23. Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med. 2003; 29:201-7.
24. Martin E, Ramsay G, Mantz J et al. The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med. 2003; 18:29-41.
25. Herr DL, Sum-Ping ST, England M. ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth. 2003; 17:576-84.
26. Ickeringill M, Shehabi Y, Adamson H et al. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: hemodynamic effects and efficacy. Anaesth Intensive Care. 2004; 32:741-5.
27. Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000; 4:302-8.
28. Corbett SM, Rebuck JA, Greene CM et al. Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med. 2005; 33:940-5.
29. Devlin JW, Fraser GL, Kanji S et al. Sedation assessment in critically ill adults. Ann Pharmacother. 2001; 35:1624-32.
30. Riker RR, Fraser GL. Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit. Pharmacotherapy. 2005; 25(5, pt. 2):8S-18S.
31. Arain SR, Ruehlow RM, Uhrich TD et al. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg. 2004; 98:153-8.
32. Ely EW, Shintani A, Truman B et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA. 2004; 291:1753-62.
33. Marshall MC, Soucy MD. Delirium in the intensive care unit. Crit Care Nurs Q. 2003; 26:172-8.
34. Newman MF, Kirchner JL, Phillips-Bute B et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001; 344:395-402.
35. Jackson JC, Hart RP, Gordon SM et al. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med. 2003; 31:1226-34.
36. Granberg Axell AI, Malmros CW, Bergbom IL et al. Intensive care unit syndrome/delirium is associated with anemia, drug therapy and duration of ventilation treatment. Acta Anaesthesiol Scand. 2002; 46:726-31.
37. Lin SM, Liu CY, Wang CH et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med. 2004; 32:2254-9.
38. Cohen IL, Gallagher JT, Pohlman AS et al. The management of the agitated ICU patient. Crit Care Med. 2002; 30:597-123.
39. Dubois MJ, Bergeron N, Dumont M et al. Delirium in an intensive care unit: a study of risk factors. Intensive Care Med. 2001; 27:1297-304.
40. Pandharipande P, Shintani A, Peterson J et at. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology. 2006; 104:21-6.
41. Maldonado JR, Wysong A, Van Der Starre PJ et al. Alpha-2 agonist induced sedation prevents ICU delirium in postcardotomy patients. J Psychosom Res. 2005; 58:61. Abstract.
42. Maldonado JR, Van Der Starre PJ, Block T et al. Dexmedetomidine: can it reduce the incidence of ICU delirium? Psychosomatics. 2004; 45:173. Abstract.
43. Maldonado JR, Wysong A, Van Der Starre PJ. The role of the novel anesthetic agent dexmedetomidine on reduction of the incidence of ICU delirium in postcardiotomy patients. J Psychosom Res. 2003; 55:150. Abstract.
44. Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery. 2005; 57(1 suppl):1-10.
45. Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology. 2000; 93:1346.
46. Ingersoll-Weng E, Manecke GR, Thistlethwaite, PA. Dexmedetomidine and cardiac arrest. Anesthesiology. 2004; 100:738-9.
47. Videira RL, Ferreira RM. Dexmedetomidine and asystole. Anesthesiology. 2004; 101:1479-80. Letter.
48. Shehabi Y, Ruettimann U, Adamson H et al. Dexmedetomidine infusion for more than 24 hours in critically ill patients: sedative and cardiovascular effects. Intensive Care Med. 2004; 30:2188-96.
49. Red book. Montvale, NJ: Thompson Healthcare; 2006.