Evaluating the use of dexmedetomidine in neurocritical care patients.
BACKGROUND
Dexmedetomidine is a highly selective alpha(2)-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Dexmedetomidine has been used in critically ill medical, surgical, and pediatric patients, as an adjunct to sedation and/or for treating drug or alcohol withdrawal. Information regarding the dosing and utilization of dexmedetomidine has been derived primarily from studies in critically ill patients in the medical intensive care unit. There has been no study designed specifically to evaluate dexmedetomidine for these therapeutic uses in the neurocritical care population. The primary and secondary objectives were to evaluate the starting dose of dexmedetomidine for neurocritical care patients and to assess the effect on hemodynamic parameters, respectively.


METHODS
This was a prospective, observational study conducted from October 2007 to March 2008. Patients were included if they were admitted to the Neuro-Intensive Care Unit and received dexmedetomidine infusion.


RESULTS
Six patients met the criteria for the study. The mean initial dexmedetomidine infusion rate and mean maximum infusion rate were 0.67 +/- 0.2 and 1.3 +/- 0.5 mcg/kg/h, respectively. The mean duration of dexmedetomidine infusion was 66 +/- 10 h. Two patients (33%) experienced a significant change in mean heart rate and systolic blood pressure after starting dexmedetomidine infusion.


CONCLUSIONS
Neurocritically ill patients may require high doses of dexmedetomidine to achieve desired levels of sedation. The high rates and long duration of dexmedetomidine infusion had a statistically, but not clinically, significant impact on hemodynamic parameters.
Grof
Tina M
TM
University of Virginia Health System, Charlottesville, VA, USA. tg9m@virginia.edu
Bledsoe
Kathleen A
KA
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D001143:Arousal / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000188:drug therapy; D055815:Young Adult
D000316:Adrenergic alpha-Agonists; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine