Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit.
Dexmedetomidine, a highly selective and potent alpha2-adrenergic agonist, has a potentially useful role as a sedative agent in patients requiring intensive care. As part of a larger European multicentre trial, a total of 119 postoperative cardiac and general surgical patients requiring ventilation and sedation in an intensive care unit were enrolled in four centres in the United Kingdom. One hundred and five patients were randomly allocated to receive either dexmedetomidine or placebo with rescue sedation and analgesia provided by midazolam and morphine, respectively. Compared with the control group, intubated patients receiving dexmedetomidine required 80% less midazolam [mean 4.9 (5.8) microg.kg-1.h-1 vs. 23.7 (27.5) microg.kg-1.h-1, p < 0.0001], and 50% less morphine [11.2 (13.4) microg.kg-1.h-1 vs. 21.5 (19.4) microg.kg-1.h-1,p = 0.0006]. Cardiovascular effects and adverse events could be predicted from the known properties of alpha-2 agonists. In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation.
Venn
R M
RM
Department of Intensive Care, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
Bradshaw
C J
CJ
Spencer
R
R
Brealey
D
D
Caudwell
E
E
Naughton
C
C
Vedio
A
A
Singer
M
M
Feneck
R
R
Treacher
D
D
Willatts
S M
SM
Grounds
R M
RM
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000009:adverse effects; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000139:chemically induced; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods; D020927:Dexmedetomidine / Q000009:adverse effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods*
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D009020:Morphine; D008874:Midazolam