Dexmedetomidine, trends and current applications

Abstract

Dexmedetomidine (DXM), is a potent, versatile and highly selective α-2 adrenergic receptor agonist, currently described as an agent with sedative, anxiolytic, sympatholytic, and hypnotic effects that preserve the integrity of respiratory functions. It has highly lipophilic chemical characteristics and conforms to a two-compartment distribution and elimination model. Among its unique pharmacodynamic characteristics, at the cardiac level there is a biphasic hemodynamic effect, with a transient increase in blood pressure and reflex bradycardia determined by its plasma concentration, at the renal level it improves ischemic damage by improving external medullary blood flow through local renal vasodilation and allowing an increase in glomerular filtration. At the respiratory level, it induces a minimal depressant effect, allowing a wide margin of safety in various surgical and sedation scenarios outside the operating room. From its neuroprotective characteristics, it is suggested that the catecholamine pathways at the level of α-2 adrenoceptors modulate the release of neurotransmitters in the central and peripheral sympathetic nervous system. They are diverse clinical applications from a “cooperative sedation”, anxiolysis in pediatric patients, during the intubation process in difficult airways, as well as its use in cardiovascular and neurological surgery and management of the critical patient.