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Minerva Anestesiologica 2018 June;84(6):731-46

DOI: 10.23736/S0375-9393.18.12350-9

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Light sedation with dexmedetomidine: a practical approach for the intensivist in different ICU patients

Stefano ROMAGNOLI 1 , Angela AMIGONI 2, Ilaria BLANGETTI 3, Giampaolo CASELLA 4, Cosimo CHELAZZI 1, Francesco FORFORI 5, Cristiana GARISTO 6, Maria C. MONDARDINI 7, Marco MOLTRASIO 8, Daniela PASERO 9, Tiziana PRINCIPI 10, Zaccaria RICCI 6, Fabio TARANTINO 11, Giorgio CONTI 12

1 Department of Anesthesiology and Intensive Care, Careggi University Hospital, Florence, Italy; 2 Pediatric Intensive Care Unit, Department of Woman’s and Child’s Health, Padua University Hospital, Padua, Italy; 3 Cardiothoracic and Vascular Intensive Care Unit, Department of Emergency and Critical Care, S. Croce and Carle Hospital, Cuneo, Italy; 4 First Service of Anesthesia and Critical Care, Intensive Care Unit, Department of Emergency, Niguarda Ca’ Granda Hospital, Milan, Italy; 5 Department of Anesthesia and Critical Care, University of Pisa, Pisa, Italy; 6 Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Institute for Research and Care, Rome, Italy; 7 Pediatric Intensive Care Unit, Department of Pediatric Anesthesia, S. Orsola-Malpighi Policlinic University Hospital, Bologna, Italy; 8 Cardiac Intensive Care Unit, Monzino Heart Center and Institute for Research and Care, Milan, Italy; 9 Service of Anesthesia and Critical Care 1, Department of Anesthesia and Critical Care, Città della Salute e della Scienza, Turin, Italy; 10 Department of Emergency, Clinic of Anesthesia and Critical Care, Ospedali Riuniti di Ancona, Ancona, Italy; 11 Department of Anesthesia and Critical Care, San Martino Policlinic Hospital, Genoa, Italy; 12 Department of Pediatric Intensive Care and Anesthesia, Sacro Cuore Catholic University, Rome, Italy


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Light sedation, corresponding to a Richmond Agitation-Sedation Scale between 0 and -1 is a priority of modern critical care practice. Dexmedetomidine, a highly selective, central, α2-adrenoceptor agonist, is increasingly administered in the intensive care units (ICUs) as an effective drug to induce light sedation, analgesia and a quasi-physiological sleep in critically ill patients. Although in general dexmedetomidine is well tolerated, side effects as bradycardia, hypertension, and hypotension may occur. Although a general dosing range is suggested, different ICU patients may require different and highly precise titration that may significantly vary due to neurological status, cardio-respiratory function, base-line blood pressure, heart rate, liver efficiency, age and co-administration of other sedatives. This review analyzes the use of dexmedetomidine in different settings including pediatric, adult, medical and surgical patients starting with some considerations on delirium prevention and sleep quality in critically ill patients and how dexmedetomidine may contribute to these crucial aspects. Dexmedetomidine use in specific sub-populations with unique characteristics will be detailed, with a special attention to a safe use.


KEY WORDS: Dexmedetomidine - Sedation - Analgesia - Intensive care medicine

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