Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit

TLDR

Dexmedetomidine, a highly selective α2‑adrenergic agonist, is a potentially useful sedative for ICU patients, with cardiovascular effects and adverse events predictable from its known pharmacology. In a multicentre UK trial, 119 postoperative cardiac and general surgical ICU patients were enrolled, and 105 were randomized to dexmedetomidine or placebo, with rescue sedation by midazolam and analgesia by morphine. Dexmedetomidine reduced midazolam use by 80% and morphine use by 50% compared with placebo, demonstrating its usefulness for postoperative analgesia and sedation.

Abstract

Dexmedetomidine, a highly selective and potent α 2 ‐adrenergic agonist, has a potentially useful role as a sedative agent in patients requiring intensive care. As part of a larger European multicentre trial, a total of 119 postoperative cardiac and general surgical patients requiring ventilation and sedation in an intensive care unit were enrolled in four centres in the United Kingdom. One hundred and five patients were randomly allocated to receive either dexmedetomidine or placebo with rescue sedation and analgesia provided by midazolam and morphine, respectively. Compared with the control group, intubated patients receiving dexmedetomidine required 80% less midazolam [mean 4.9 (5.8) μg.kg −1 .h −1 vs. 23.7 (27.5) μg.kg −1 .h −1 , p < 0.0001], and 50% less morphine [11.2 (13.4) μg.kg −1 .h −1 vs. 21.5 (19.4) μg.kg −1 .h −1 ,p = 0.0006]. Cardiovascular effects and adverse events could be predicted from the known properties of alpha‐2 agonists. In conclusion, dexmedetomidine is a useful agent for the provision of postoperative analgesia and sedation.