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Safety and efficacy of dexmedetomidine for long-term sedation in critically ill patients.

Ozaki M, Takeda J, Tanaka K, Shiokawa Y, Nishi S, Matsuda K, Doi M, Kakihana Y, Fujino Y, Takinami M, Kawai M - J Anesth (2013)

Bottom Line: We evaluated the safety and efficacy of long-term administration of dexmedetomidine in patients in the intensive care unit (ICU).Safety and efficacy of short-term (≤ 24 h) and long-term (>24 h) dexmedetomidine administration were compared.Long-term safety of dexmedetomidine compared to its use for 24 h was confirmed.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Tokyo Women's Medical University Hospital, Tokyo, Japan.

ABSTRACT

Purpose: We evaluated the safety and efficacy of long-term administration of dexmedetomidine in patients in the intensive care unit (ICU). Primary endpoint was the incidence of hypotension, hypertension, and bradycardia. Secondary endpoints were withdrawal symptoms, rebound effects, the duration of sedation with Richmond Agitation-Sedation Scale (RASS) ≤ 0 relative to the total infusion time of dexmedetomidine, and the dose of additional sedatives or analgesics.

Methods: Dexmedetomidine 0.2-0.7 μg/kg/h was continuously infused for maintaining RASS ≤ 0 in patients requiring sedation in the ICU. Safety and efficacy of short-term (≤ 24 h) and long-term (>24 h) dexmedetomidine administration were compared.

Results: Seventy-five surgical and medical ICU patients were administered dexmedetomidine. The incidence of hypotension, hypertension, and bradycardia that occurred after 24 h (long-term) was not significantly different from that occurring within 24 h (short-term) (P = 0.546, 0.513, and 0.486, respectively). Regarding withdrawal symptoms, one event each of hypertension and headache occurred after the end of infusion, but both were mild in severity. Increases of mean arterial blood pressure and heart rate after terminating the infusion of dexmedetomidine were not associated with the increasing duration of its infusion. The ratio of duration with RASS ≤ 0 was ≥ 85 % until day 20, except day 9 (70 %) and day 10 (75 %). There was no increase in the dose of additional sedatives or analgesics after the first 24-h treatment period.

Conclusions: Long-term safety of dexmedetomidine compared to its use for 24 h was confirmed. Dexmedetomidine was useful to maintain an adequate sedation level (RASS ≤ 0) during long-term infusion.

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Related in: MedlinePlus

The ratio of duration with the Richmond Agitation-Sedation Scale ≤ 0 during dexmedetomidine treatment was calculated for each patient and mean ± SD values were analyzed. There were 75 patients on day 1, 73 on day 2, 37 on day 3, 26 on day 4, 18 on day 5, 13 on day 6, 11 on day 7, 9 on day 8, 8 on days 9–12, 5 on day 13, 4 on days 14–15, 2 on days 16–18, and 1 on days 19–20
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Fig4: The ratio of duration with the Richmond Agitation-Sedation Scale ≤ 0 during dexmedetomidine treatment was calculated for each patient and mean ± SD values were analyzed. There were 75 patients on day 1, 73 on day 2, 37 on day 3, 26 on day 4, 18 on day 5, 13 on day 6, 11 on day 7, 9 on day 8, 8 on days 9–12, 5 on day 13, 4 on days 14–15, 2 on days 16–18, and 1 on days 19–20

Mentions: During administration of the study drug, the patients were within the target sedation range (RASS ≤ 0) 85 % of the time, except on days 9–10. On days 9–10, a medical ICU patient with agitation (including tube pulling and aggressive behavior) and another patient with daytime arousal (RASS > 0) were observed, and the ratio of duration in the target sedation range decreased to approximately 70–75 % (Fig. 4).Fig. 4


Safety and efficacy of dexmedetomidine for long-term sedation in critically ill patients.

Ozaki M, Takeda J, Tanaka K, Shiokawa Y, Nishi S, Matsuda K, Doi M, Kakihana Y, Fujino Y, Takinami M, Kawai M - J Anesth (2013)

The ratio of duration with the Richmond Agitation-Sedation Scale ≤ 0 during dexmedetomidine treatment was calculated for each patient and mean ± SD values were analyzed. There were 75 patients on day 1, 73 on day 2, 37 on day 3, 26 on day 4, 18 on day 5, 13 on day 6, 11 on day 7, 9 on day 8, 8 on days 9–12, 5 on day 13, 4 on days 14–15, 2 on days 16–18, and 1 on days 19–20
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3921449&req=5

Fig4: The ratio of duration with the Richmond Agitation-Sedation Scale ≤ 0 during dexmedetomidine treatment was calculated for each patient and mean ± SD values were analyzed. There were 75 patients on day 1, 73 on day 2, 37 on day 3, 26 on day 4, 18 on day 5, 13 on day 6, 11 on day 7, 9 on day 8, 8 on days 9–12, 5 on day 13, 4 on days 14–15, 2 on days 16–18, and 1 on days 19–20
Mentions: During administration of the study drug, the patients were within the target sedation range (RASS ≤ 0) 85 % of the time, except on days 9–10. On days 9–10, a medical ICU patient with agitation (including tube pulling and aggressive behavior) and another patient with daytime arousal (RASS > 0) were observed, and the ratio of duration in the target sedation range decreased to approximately 70–75 % (Fig. 4).Fig. 4

Bottom Line: We evaluated the safety and efficacy of long-term administration of dexmedetomidine in patients in the intensive care unit (ICU).Safety and efficacy of short-term (≤ 24 h) and long-term (>24 h) dexmedetomidine administration were compared.Long-term safety of dexmedetomidine compared to its use for 24 h was confirmed.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Tokyo Women's Medical University Hospital, Tokyo, Japan.

ABSTRACT

Purpose: We evaluated the safety and efficacy of long-term administration of dexmedetomidine in patients in the intensive care unit (ICU). Primary endpoint was the incidence of hypotension, hypertension, and bradycardia. Secondary endpoints were withdrawal symptoms, rebound effects, the duration of sedation with Richmond Agitation-Sedation Scale (RASS) ≤ 0 relative to the total infusion time of dexmedetomidine, and the dose of additional sedatives or analgesics.

Methods: Dexmedetomidine 0.2-0.7 μg/kg/h was continuously infused for maintaining RASS ≤ 0 in patients requiring sedation in the ICU. Safety and efficacy of short-term (≤ 24 h) and long-term (>24 h) dexmedetomidine administration were compared.

Results: Seventy-five surgical and medical ICU patients were administered dexmedetomidine. The incidence of hypotension, hypertension, and bradycardia that occurred after 24 h (long-term) was not significantly different from that occurring within 24 h (short-term) (P = 0.546, 0.513, and 0.486, respectively). Regarding withdrawal symptoms, one event each of hypertension and headache occurred after the end of infusion, but both were mild in severity. Increases of mean arterial blood pressure and heart rate after terminating the infusion of dexmedetomidine were not associated with the increasing duration of its infusion. The ratio of duration with RASS ≤ 0 was ≥ 85 % until day 20, except day 9 (70 %) and day 10 (75 %). There was no increase in the dose of additional sedatives or analgesics after the first 24-h treatment period.

Conclusions: Long-term safety of dexmedetomidine compared to its use for 24 h was confirmed. Dexmedetomidine was useful to maintain an adequate sedation level (RASS ≤ 0) during long-term infusion.

Show MeSH
Related in: MedlinePlus