title: A new dosing protocol reduces dexmedetomidine-associated hypotension in critically ill surgical patients.
abstract: BACKGROUND
  Although no ideal sedative exists, dexmedetomidine is unique because it produces sedation and analgesia without decreasing the respiratory drive. Hemodynamic responses to dexmedetomidine are variable and dependent on the patient population. Our initial experience was associated with an unacceptable incidence of hypotension and bradycardia. We evaluated occurrence of hypotension and bradycardia in critically ill surgical patients receiving dexmedetomidine before and after implementation of a dosing protocol.
  
  
  METHODS
  This is a retrospective chart review of all admissions to a university medical center-based, 44-bed surgical intensive care unit pre and post protocol implementation.
  
  
  RESULTS
  Forty-four patients received dexmedetomidine including 19 historic controls and 25 dosed via protocol. Both groups had comparable demographics and initial and maximum dosages of dexmedetomidine. Use of the dosing protocol resulted in fewer dosage changes (mean +/- standard deviation, 4.8 +/- 3.8 compared to 7.8 +/- 3.9; P = .014) and fewer episodes of hypotension (16% vs 68.4%; P = .0006) but did not influence bradycardic episodes (20% vs 15.5%; P > .99).
  
  
  CONCLUSIONS
  We found that use of a protocol that increases the time interval between dosage adjustments may reduce dexmedetomidine-associated hypotension.
authors.affiliation: Department of Pharmacy, The Ohio State University Medical Center, Columbus, Ohio 43210, USA. gerlach.6@osu.edu
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Dasta
authors.forename: Steven
authors.initials: S
authors.lastname: Steinberg
authors.forename: Larry C
authors.initials: LC
authors.lastname: Martin
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D001919:Bradycardia / Q000139:chemically induced / Q000517:prevention & control; D002985:Clinical Protocols; D016638:Critical Illness; D020927:Dexmedetomidine / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D007022:Hypotension / Q000139:chemically induced* / Q000517:prevention & control; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
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