The effects of increasing plasma concentrations of dexmedetomidine in humans.
BACKGROUND
This study determined the responses to increasing plasma concentrations of dexmedetomidine in humans.


METHODS
Ten healthy men (20-27 yr) provided informed consent and were monitored (underwent electrocardiography, measured arterial, central venous [CVP] and pulmonary artery [PAP] pressures, cardiac output, oxygen saturation, end-tidal carbon dioxide [ETCO2], respiration, blood gas, and catecholamines). Hemodynamic measurements, blood sampling, and psychometric, cold pressor, and baroreflex tests were performed at rest and during sequential 40-min intravenous target infusions of dexmedetomidine (0.5, 0.8, 1.2, 2.0, 3.2, 5.0, and 8.0 ng/ml; baroreflex testing only at 0.5 and 0.8 ng/ml).


RESULTS
The initial dose of dexmedetomidine decreased catecholamines 45-76% and eliminated the norepinephrine increase that was seen during the cold pressor test. Catecholamine suppression persisted in subsequent infusions. The first two doses of dexmedetomidine increased sedation 38 and 65%, and lowered mean arterial pressure by 13%, but did not change central venous pressure or pulmonary artery pressure. Subsequent higher doses increased sedation, all pressures, and calculated vascular resistance, and resulted in significant decreases in heart rate, cardiac output, and stroke volume. Recall and recognition decreased at a dose of more than 0.7 ng/ml. The pain rating and mean arterial pressure increase to cold pressor test progressively diminished as the dexmedetomidine dose increased. The baroreflex heart rate slowing as a result of phenylephrine challenge was potentiated at both doses of dexmedetomidine. Respiratory variables were minimally changed during infusions, whereas acid-base was unchanged.


CONCLUSIONS
Increasing concentrations of dexmedetomidine in humans resulted in progressive increases in sedation and analgesia, decreases in heart rate, cardiac output, and memory. A biphasic (low, then high) dose-response relation for mean arterial pressure, pulmonary arterial pressure, and vascular resistances, and an attenuation of the cold pressor response also were observed.
Department of Anesthesiology, The Medical College of Wisconsin and the VA Medical Center, Milwaukee 53295, USA. tjbert@mcw.edu
T J
TJ
Ebert
J E
JE
Hall
J A
JA
Barney
T D
TD
Uhrich
M D
MD
Colinco
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000097:blood* / Q000494:pharmacology*; D000328:Adult; D016292:Procedural Sedation; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000097:blood* / Q000494:pharmacology*; D004305:Dose-Response Relationship, Drug; D004357:Drug Synergism; D004837:Epinephrine / Q000097:blood; D008401:Gas Chromatography-Mass Spectrometry; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D011939:Mental Recall / Q000187:drug effects; D009638:Norepinephrine / Q000097:blood; D010656:Phenylephrine / Q000494:pharmacology; D011311:Pressoreceptors / Q000187:drug effects*; D011594:Psychometrics; D012044:Regression Analysis
D000316:Adrenergic alpha-Agonists; D010656:Phenylephrine; D020927:Dexmedetomidine; D009638:Norepinephrine; D004837:Epinephrine