Dexmedetomidine in ICU delirium
"........Dexmedetomidine, a novel α2-receptor agonist that does not act on GABA receptors, may prove to be an alternative sedative agent that is less likely to cause delirium. In a preliminary report of an unblinded, randomized trial conducted in postoperative cardiac surgical patients, Maldonado and colleagues described a significant reduction in the incidence of delirium associated with dexmedetomidine; 8% of patients sedated with dexmedetomidine at sternal closure developed delirium as compared with 50% of patients sedated with propofol or midazolam. Similarly, in a recently completed double-blind, randomized controlled trial it was determined that ICU patients sedated with dexmedetomidine spent fewer days in coma and more days neurologically normal (without coma or delirium) than did those sedated with lorazepam. These pilot studies suggest that larger trials are warranted to evaluate the efficacy and safety of sedation with dexmedetomidine as well as clonidine, a less selective α2-receptor agonist, in ICU patients".
"........Dexmedetomidine, a novel α2-receptor agonist that does not act on GABA receptors, may prove to be an alternative sedative agent that is less likely to cause delirium. In a preliminary report of an unblinded, randomized trial conducted in postoperative cardiac surgical patients, Maldonado and colleagues described a significant reduction in the incidence of delirium associated with dexmedetomidine; 8% of patients sedated with dexmedetomidine at sternal closure developed delirium as compared with 50% of patients sedated with propofol or midazolam. Similarly, in a recently completed double-blind, randomized controlled trial it was determined that ICU patients sedated with dexmedetomidine spent fewer days in coma and more days neurologically normal (without coma or delirium) than did those sedated with lorazepam. These pilot studies suggest that larger trials are warranted to evaluate the efficacy and safety of sedation with dexmedetomidine as well as clonidine, a less selective α2-receptor agonist, in ICU patients".
Reference: Delirium in the intensive care unit - Crit Care. 2008; 12(Suppl 3): S3. , Published online 2008 May 14. - Timothy D Girard, Pratik P Pandharipande and E Wesley Ely
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