DEXMEDETOMIDINE
Dexmedetomidine (Precedex) is a
parenteralselective α2
agonist with sedative properties. It appears to be more selective for the α2 receptor than clonidine. At higher
doses it loses its selectivity and also stimulates α1-adrenergic receptors.
Dexmedetomidine causes dose-dependent
sedation anxiolysis and some analgesia and blunts the sym-pathetic response to
surgery and other stress. Most importantly, it has an opioid-sparing effect and
does not significantly depress respiratory drive; excessive sedation, however,
may cause airway obstruction. The drug is used for short-term (<24
h), intrave-nous sedation of mechanically ventilated patients. Discontinuation
after more prolonged use can potentially cause a withdrawal phenomenon simi-lar
to that of clonidine. It has also been used for intraoperative sedation and as
an adjunct to general anesthetics.
The principal side effects are
bradycardia, heart block, and hypotension. It may also cause nausea.
The recommended initial loading dose is
1 mcg/kg intravenously over 10 min with a maintenanceinfusion rate of 0.2–0.7
mcg/kg/h. Dexmedetomi-dine has a rapid onset and terminal half-life of 2 h. The
drug is metabolized in the liver and its metab-olites are eliminated in the
urine. Dosage should be reduced in patients with renal insufficiency or hepatic
impairment.
Caution should be used when
dexmedetomidine is administered with vasodilators, cardiac depressants, and
drugs that decrease heart rate. Reduced require-ments of hypnotics/anesthetic
agents should prevent excessive hypotension.
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