Safety and efficacy of dexmedetomidine in neurosurgical patients.
OBJECTIVE
Very little information regarding effects on ICP, CPP and the safety of dexmedetomidine in neurosurgical patients has been published. The objective of this study is to gather information on the dosage, sedative effects and adverse effects of dexmedetomidine in neurosurgical patients.


METHODS
The study design was retrospective and descriptive.


METHODS
Computerized data were collected from the records of 39 neurosurgical patients in the ICU who received dexmedetomidine between October 2001 and December 2004. MAP, SBP, DBP, HR, ICP and CPP were recorded. The parameter means and standard deviations were obtained and plotted against time.


METHODS
Dexmedetomidine, an alpha-2 agonist, provides adequate sedation without altering respiratory drive, while facilitating frequent neurological examinations. The FDA approved a dosage range for a loading infusion of 0.1 mcg kg-1 infused over 10 minutes followed by 0.2-0.7 mcg kg-1 h-1 continuous infusion for 24 hours.


RESULTS
A total of 39 patients were enrolled in the study; 26 men and 13 women. The mean age was 34 years. Of the patients enrolled in the study, 15 were successfully extubated with no adverse reactions while maintaining adequate sedation. Agitation was the predominant adverse reaction. Hypotension occurred in 10 patients. The mean CPP increased and the mean ICP decreased. The standard deviation for the means of the ICP and CPP were small and did not fluctuate as widely as the haemodynamic parameters.


CONCLUSIONS
Dexmedetomidine can be a safe and effective sedative agent for neurosurgical patients. A loading infusion should be avoided and higher maintenance doses may be required to ensure adequate sedation. Further studies are necessary to establish an optimal dosage regimen.
Aryan
Henry E
HE
Division of Neurosurgery, University of California, San Diego, CA 92103-8893, USA. hearyan@ucsd.edu
Box
Kevin W
KW
Ibrahim
Dalia
D
Desiraju
Usha
U
Ames
Christopher P
CP
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D001930:Brain Injuries / Q000503:physiopathology / Q000601:surgery*; D016292:Procedural Sedation; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007427:Intracranial Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged
D000316:Adrenergic alpha-Agonists; D020927:Dexmedetomidine