Korean J Anesthesiol Search


Bae: Dexmedetomidine: an attractive adjunct to anesthesia
Dexmedetomidine is a new alpha 2-adrenoceptor agonist approved for use as a sedative and analgesic in intensive care units (ICUs). Dexmedetomidine is seven to eight times more specific to the alpha-2 receptor than the partial agonist clonidine. In addition to its sedative properties, dexmedetomidine has opioidsparing, anxiolytic, sympatholytic, and respiratory-preserving properties and provides superior hemodynamic stability compared with many sedative agents now in use [1]. Dexmedetomidine is widely used for sedation in the ICU because of its beneficial effects. A previous study showed that dexmedetomidine is associated with a shortened time to extubation and reduced prevalence of delirium in critically ill patients receiving mechanical ventilation [2,3]. A recent study reported that dexmedetomidine decreases the duration of mechanical ventilation and also enhances the rate of resolution of delirium in critically ill patients with agitated delirium [4].
The clinical applications of alpha 2-adrenergic agonists have been expanded in the field of anesthesia since they were first used as anti-hypertensive agents. Dexmedetomidine reduces the minimum alveolar concentration of inhalation anesthetics, reduces opioid requirement, and has anti-nociceptive effects on both somatic and visceral pain when used as an anesthetic adjunct administered via the neuraxial route [5]. Local injection of dexmedetomidine diminishes the neuropathic pain induced by spinal nerve ligation in animal models, and systemic administration of dexmedetomidine reduces post-thoracotomy pain syndrome after coronary artery bypass surgery [6,7]. A recent study showed that use of dexmedetomidine as a sedative in elderly patients receiving orthopedic surgery reduces postoperative agitation compared to propofol [8]. The favorable properties of dexmedetomidine, such as minimal respiratory depression, may provide protection against adverse respiratory events during anesthesia for awake craniotomy or awake intubation [9,10].
Many studies have demonstrated that dexmedetomidine has organ-protective effects in various anesthetic conditions. Previous studies have reported that the use of alpha 2-adrenergic agonists can reduce mortality and myocardial infarction in patients undergoing vascular surgery, and also provides a cardioprotective effect during cardiac surgery [11]. Dexmedetomidine preserves cerebral blood flow (CBF) and cerebral metabolic rate (CMR) coupling by dose-dependently reducing CBF and CMR in healthy humans [12]. Growing evidence suggests that dexmedetomidine confers neuroprotective effects in various experimental models, including hypoxia-induced ischemia, subarachnoid hemorrhage, and ischemia/reperfusion injury [13,14,15]. A recent clinical trial showed that continuous infusion of dexmedetomidine during cardiopulmonary bypass surgery decreases the incidence and severity of acute kidney injury [16].
Although the various beneficial properties of dexmedetomidine have expanded its clinical use in many areas, serious side effects, such as cardiac arrest, have been reported in several studies [17,18]. These reports suggest that dexmedetomidine should be used with caution in patients with certain conditions in which sympathetic function is suppressed or parasympathetic function is enhanced. Fujita et al. [19] reported that plasma dexmedetomidine concentration is correlated with the infusion dose in critically ill adult patients, but not in children < 2 years old admitted to the pediatric ICU [20]. These reports emphasize the need for close monitoring, individualized treatment, and dose adjustment to achieve the desired clinical response when administering dexmedetomidine. In conclusion, dexmedetomidine is a new alpha 2-adrenoceptor agonist with promising sedative and analgesic properties. The unique properties of dexmedetomidine, including anxiolytic and opioid-sparing properties and minimal respiratory depression, make it a very attractive drug in the fields of intensive care and anesthesia.


1. Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res 2011; 5: 128-133. PMID: 25885374.
crossref pmid pmc
2. Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 2009; 301: 489-499. PMID: 19188334.
crossref pmid
3. Jakob SM, Ruokonen E, Grounds RM, Sarapohja T, Garratt C, Pocock SJ, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JAMA 2012; 307: 1151-1160. PMID: 22436955.
crossref pmid
4. Reade MC, Eastwood GM, Bellomo R, Bailey M, Bersten A, Cheung B, et al. Effect of dexmedetomidine added to standard care on ventilator-free time in patients with agitated delirium: a randomized clinical trial. JAMA 2016; 315: 1460-1468. PMID: 26975647.
crossref pmid
5. Gupta R, Verma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine. J Anaesthesiol Clin Pharmacol 2011; 27: 339-343. PMID: 21897504.
crossref pmid pmc
6. Lee HG, Choi JI, Kim YO, Yoon MH. The role of alpha-2 adrenoceptor subtype in the antiallodynic effect of intraplantar dexmedetomidine in a rat spinal nerve ligation model. Neurosci Lett 2013; 557: 118-122. PMID: 24161890.
crossref pmid
7. Jabbary Moghaddam M, Barkhori A, Mirkheshti A, Hashemian M, Amir Mohajerani S. The effect of pre-emptive dexmedetomidine on the incidence of post-thoracotomy pain syndrome in patients undergoing coronary artery bypass grafting. Anesth Pain Med 2016; 6: e36344PMID: 27660748.
crossref pmid pmc
8. Shin HJ, Koo BW, Bang SU, Kim JH, Hwang JW, DO SH, et al. Intraoperative dexmedetomidine sedation reduces the postoperative agitated behaviour in elderly patients undergoing orthopaedic surgery compared to the propofol sedation: a retrospective analysis of 855 patients. Minerva Anestesiol 2017;[Epub ahead of print].
9. Goettel N, Bharadwaj S, Venkatraghavan L, Mehta J, Bernstein M, Manninen PH. Dexmedetomidine vs propofol-remifentanil conscious sedation for awake craniotomy: a prospective randomized controlled trial. Br J Anaesth 2016; 116: 811-821. PMID: 27099154.
crossref pmid pdf
10. Zhou LJ, Fang XZ, Gao J, Zhangm Y, Tao LJ. Safety and efficacy of dexmedetomidine as a sedative agent for performing awake intubation: a meta-analysis. Am J Ther 2016; 23: e1788-e1800.
crossref pmid
11. Wijeysundera DN, Naik JS, Beattie WS. Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med 2003; 114: 742-752. PMID: 12829201.
crossref pmid
12. Drummond JC, Dao AV, Roth DM, Cheng CR, Atwater BI, Minokadeh A, et al. Effect of dexmedetomidine on cerebral blood flow velocity, cerebral metabolic rate, and carbon dioxide response in normal humans. Anesthesiology 2008; 108: 225-232. PMID: 18212567.
crossref pmid
13. Pan W, Lin L, Zhang N, Yuan F, Hua X, Wang Y, et al. Neuroprotective effects of dexmedetomidine against hypoxia-induced nervous system injury are related to inhibition of NF-κB/COX-2 pathways. Cell Mol Neurobiol 2016; 36: 1179-1188. PMID: 26683659.
crossref pmid pdf
14. Wang Y, Han R, Zuo Z. Dexmedetomidine post-treatment induces neuroprotection via activation of extracellular signal-regulated kinase in rats with subarachnoid haemorrhage. Br J Anaesth 2016; 116: 384-392. PMID: 26865131.
crossref pmid pmc pdf
15. Wu GJ, Chen JT, Tsai HC, Chen TL, Liu SH, Chen RM. Protection of dexmedetomidine against ischemia/reperfusion-induced apoptotic insults to neuronal cells occurs via an intrinsicmitochondria-dependent pathway. J Cell Biochem 2017; 118: 2635-2644. PMID: 27987330.
crossref pmid
16. Cho JS, Shim JK, Soh S, Kim MK, Kwak YL. Perioperative dexmedetomidine reduces the incidence and severity of acute kidney injury following valvular heart surgery. Kidney Int 2016; 89: 693-700. PMID: 26444030.
crossref pmid
17. Kim BJ, Kim BI, Byun SH, Kim E, Sung SY, Jung JY. Cardiac arrest in a patient with anterior fascicular block after administration of dexmedetomidine with spinal anesthesia: A case report. Medicine (Baltimore) 2016; 95: e5278PMID: 27787391.
crossref pmid pmc
18. Ingersoll-Weng E, Manecke GR Jr, Thistlethwaite PA. Dexmedetomidine and cardiac arrest. Anesthesiology 2004; 100: 738-739. PMID: 15108994.
crossref pmid
19. Fujita Y, Inoue K, Sakamoto T, Yoshizawa S, Tomita M, Maeda Y, et al. A comparison between dosages and plasma concentrations of dexmedetomidine in clinically ill patients: a prospective, observational, cohort study in Japan. J Intensive Care 2013; 1: 15PMID: 25705407.
crossref pmid pmc
20. Fujita Y, Inoue K, Sakamoto T, Yoshizawa S, Tomita M, Toyo’oka T, et al. The relationship between dexmedetomidine dose and plasma dexmedetomidine concentration in critically ill infants: a prospective, observational cohort study. Korean J Anesthesiol 2017; 70: 426-433.
crossref pmid pmc


Browse all articles >

Editorial Office
101-3503, Lotte Castle President, 109 Mapo-daero, Mapo-gu, Seoul 04146, Korea
Tel: +82-2-792-5128    Fax: +82-2-792-4089    E-mail: journal@anesthesia.or.kr                

Copyright © 2024 by Korean Society of Anesthesiologists.

Developed in M2PI

Close layer
prev next