Dexmedetomidine Case Study

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RESPIRATORY EFFECTS Dexmedetomidine is able to achieve its sedative, hypnotic and analgesic effects without causing any clinically relevant respiratory depression unlike opioids. The changes in ventilation appeared similar to those observed during natural sleep. Dexmedetomidine do not cause any changes in arterial oxygenation, pH and respiratory rate.(67) It also exhibited a hypercarbic arousal phenomenon, which has been described during normal sleep and is a safety feature. The obstructive respiratory pattern and irregular breathing seen with high doses of 1-2µg/kg given over 2 minutes and are probably related more to deep sedation and anatomical features of the patient and this could be easily overcome by insertion of an oral airway.(72)…show more content…
Use of dexmedetomidine for regional anaesthesia a. Epidural dexmedetomidine at a dose of 100µg decreased the incidence of postoperative shivering.(87) b. Intrathecal dexmedetomidine at a dose of 3µg causes significant prolongation of sensory and motor blockade.(88) c. Addition of 0.5µg/kg body weight of dexmedetomidine to lidocaine for intravenous regional anaesthesia improves the quality of anaesthesia and perioperative analgesia.(89) 3. Use in monitored anaesthesia care (MAC): Dexmedetomidine confers arousable sedation with ease of orientation, anxiolysis, mild analgesia without respiratory depression.(90) 4. Dexmedetomidine has also been used as sole anaesthetic agent upto doses of 10µg/kg/hr.(75) 5. Use of dexmedetomidine in postoperative period: infusion can be continued in extubated and spontaneously breathing patients. The ongoing sedation and sympatholytic effect is beneficial in reducing postoperative myocardial ischemic events in high risk patients undergoing non-cardiac surgery.(90) 6. Use of dexmedetomidine in paediatric age group:(91) addition of dexmedetomidine 2µg/kg body weight to bupivacaine for caudal analgesia promotes analgesia after anaesthetic recovery without increasing the incidence of side…show more content…
The maintenance dose is titrated until the sedation goal is reached. It is not necessary to discontinue Dexmedetomidine before, during or after extubation. Dose up to 2.5µg/kg/hr for up to seven days, with no rebound effect on withdrawal and no compromise in haemodynamics stability have been used in clinical trials.(95) Drug interactions Dexmedetomidine has shown to inhibit CYP2 D6 in vitro, but the clinical significance of this inhibition is not well established. Dexmedetomidine appears to have little potential for interactions with drugs metabolized by the cytochrome p450 system. Co-administration of Dexmedetomidine with sevoflurane, isoflurane, propofol, alfentanil and midazolam may result in enhancement of sedative, hypnotic or anaesthetic

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