• Dexmedetomidine
• Idazoxan
• Naloxone
• Toxicity

• Animals
• Dexmedetomidine/toxicity
• Mice
• Male
• Adrenergic alpha-2 Receptor Agonists/toxicity
• Adrenergic alpha-2 Receptor Antagonists/pharmacology
• Dose-Response Relationship, Drug
• Lethal Dose 50
• Hypnotics and Sedatives/toxicity
• Receptors, Adrenergic, alpha-2/metabolism
• Yohimbine/pharmacology
• Imidazoles/pharmacology

• Dexmedetomidine
• In-hospital mortality
• Midazolam
• Propofol
• Sedatives
• Subarachnoid hemorrhage

• Humans
• Male
• Middle Aged
• Aged
• Subarachnoid Hemorrhage/mortality
• Subarachnoid Hemorrhage/surgery
• Hospital Mortality
• Dexmedetomidine
• Hypnotics and Sedatives
• Propofol
• Midazolam
• Endovascular Procedures
• Boston/epidemiology

• adverse drug events (ADEs)
• antihypertensive drugs
• drug‐induced hypotension
• pharmacovigilance
• systematic literature search

• Adult
• Humans
• Antihypertensive Agents/adverse effects
• Hypotension/chemically induced

• None

• bioavailability
• dexmedetomidine
• nasal spray
• pharmacodynamics
• pharmacokinetics

• delirium
• hemodynamics
• intensive care unit
• plasma norepinephrine

• University International Hospital Research Funds

• Dexmedetomidine
• FDA adverse event reporting system
• adverse event
• real-world
• safety

• Anaesthesia
• Ethiopia
• dexmedetomidine
• haemodynamic
• perioperative
• surgery

• Acute ischemic stroke
• Dexmedetomidine
• Endovascular thrombectomy
• Postoperative prolonged sedation

• Humans
• Ischemic Stroke/diagnosis
• Ischemic Stroke/surgery
• Dexmedetomidine/adverse effects
• Prospective Studies
• Reperfusion
• Thrombectomy/adverse effects
• Stroke/diagnosis
• Stroke/therapy
• Reperfusion Injury/etiology
• Reperfusion Injury/prevention & control
• Prognosis
• Randomized Controlled Trials as Topic

• 2022-2Z-2039 Capital's Funds for Health Improvement and Research
• Capital’s Funds for Health Improvement and Research

• UL1TR002345 NCATS NIH HHS
• UL1TR002345 NCATS NIH HHS

• dental rehabilitation
• emergence delirium
• intranasal dexmedetomidine
• pediatric patients
• sevoflurane anesthesia

• Humans
• Child
• Dexmedetomidine
• Emergence Delirium/prevention & control
• Emergence Delirium/drug therapy
• Hypnotics and Sedatives/therapeutic use
• Sevoflurane
• Administration, Intranasal
• Anesthesia, General/adverse effects
• Double-Blind Method
• Anesthesia Recovery Period

• analgesia
• dexmedetomidine
• pain
• preterm infants
• sedation

• Ketamine
• Meta-analysis
• Nebulization
• Pediatrics
• Sedation

• Child
• Humans
• Dexmedetomidine/therapeutic use
• Ketamine
• Emergence Delirium/drug therapy
• Randomized Controlled Trials as Topic
• Hypnotics and Sedatives/therapeutic use

• 2020YFS0035 Science and Technology Plan Project of Sichuan Province

• Dexmedetomidine
• MACE
• MINS
• Myocardial injury

• BRA2020089 333 High-level Talent Training Project in Jiangsu Province
• WSN-022 Six talent peaks project in Jiangsu Province

• Child
• Humans
• Midazolam/therapeutic use
• Ketamine
• Dexmedetomidine/therapeutic use
• Hypnotics and Sedatives/therapeutic use
• Premedication
• Strabismus/surgery
• Strabismus/drug therapy

• analgesia
• conscious sedation
• dexmedetomidine
• innovative
• midazolam
• minor oral surgery
• third molar surgery

• anaesthesia
• conscious sedation
• dexmedetomidine
• remifentanil
• vitrectomy

• Anesthesiology
• Conscious sedation
• Dexmedetomidine
• Hypnotics and sedatives
• Patient safety

• dexmedetomidine
• pediatric anesthesia
• perioperative respiratory adverse event

• dexmedetomidine
• ketamine
• procedural interference
• propofol
• rescue bolus
• sedation

• Deep sedation
• dexmedetomidine
• endobronchial ultrasound
• moderate sedation
• propofol
• remifentanil

Postoperative cognitive dysfunction (POCD) is a complication that mainly occurs in adult patients and refers to a new-onset decline in cognitive function after anesthesia and surgery. The literature lacks evidence regarding opioid-free anesthesia and its impact on mental function postoperatively.

The effect of opioid-free anesthesia on POCD following urological surgery has not been previously reported. Accordingly, we present a case series of 15 adult patients undergoing transurethral urological surgery under general anesthesia using an opioid-free protocol with dexmedetomidine, ketamine, and lidocaine.

Patients that underwent simple transurethral elective urological procedures under general opioid-free anesthesia were included. This case series is part of a prospective clinical study regarding opioid-free anesthesia and served as a pilot sample. The mini-mental state examination (MMSE) test, performed preoperatively and 12 hours postoperatively, was applied to assess POCD.

Fifteen patients with a mean age of 68 years old were included in the study. The opioid-free protocol was associated with non-statistically significant changes of the MMSE test after minor urological procedures.

In our study, an opioid-free protocol of general anesthesia, using a mixture of dexmedetomidine, ketamine, and lidocaine, did not seem to have a negative impact on postoperative cognitive function in patients undergoing transurethral urological surgery. Further studies specifically designed to identify this effect are certainly required to further prove such an effect.

• children
• dexmedetomidine
• mucosal atomization device
• sedation
• spray
• surgery

To compare the sedoanalgesic effects of dexmedetomidine alone or with combination of ketamine.

After getting ethical approval and informed patient consent, 60 adult surgical patients, were randomly divided into two groups. Group KD (n = 30); received dexmedotomidine 0.5 μg/kg/h mixed with ketamine 0.5 μg/kg/h and Group DEX (n = 30); received dexmedotomidine at 0.5 mg/kg/h infusion only. In both the groups, study drugs were titrated (dexmedetomidine- 0.2-0.7 μg/kg/h and ketamine 0.2-0.7 mg/kg/h) to achieve target sedation. Hemodynamic variables, pain scores, sedation scores, and patient satisfaction were recorded. Qualitative and Quantitative data were analyzed with Pearson Chi-squared test and analysis of variance test, respectively. All analyses were done by using statistical package for social sciences (SPSS) version 16.0.

Pain scores were higher in group DEX than in group KD at 2 h and 4 h which was statistically significant (P < 0.05). At the end of 2 h, sedation scores were higher in group KD than in group DEX and was statistically significant (P < 0.05). Length of intensive care unit stay was almost comparable in both groups, and the time to tracheal extubation was lesser in ketamine-dexmedetomidine group as compared to the dexmedetomidine alone group. However the difference was statistically non-significant.

By combining dexmedetomidine with ketamine we observed lower incidence of hypotension and bradycardia. Dexmedetomidine with ketamine combination therapy could be used safely and effectively as sedo-analgesic agent.

• Blood loss
• Dexmedetomidine
• Orthognathic surgery

• Adult
• Blood Loss, Surgical/prevention & control
• Case-Control Studies
• Dexmedetomidine/administration & dosage
• Female
• Follow-Up Studies
• Humans
• Hypnotics and Sedatives/administration & dosage
• Infusions, Intravenous
• Intraoperative Complications/prevention & control
• Male
• Orthognathic Surgery/methods
• Prognosis
• Retrospective Studies
• Young Adult

Dexmedetomidine, selective α2-adrenergic agonist dexmedetomidine, has been widely used clinically for sedation and anesthesia. The role of dexmedetomidine has been an interesting topic of neonatological and anesthetic research since a series of advantages of dexmedetomidine, such as enhancing recovery from surgery, reducing opioid prescription, decreasing sympathetic tone, inhibiting inflammatory reactions, and protecting organs, were reported. Particularly, an increasing number of animal studies have demonstrated that dexmedetomidine ameliorates the neurological outcomes associated with various brain and spinal cord injuries. In addition, a growing number of clinical trials have reported the efficacy of dexmedetomidine for decreasing the rates of postoperative neurological dysfunction, such as delirium and stroke, which strongly highlights the possibility of dexmedetomidine functioning as a neuroprotective agent for future clinical use. Mechanism studies have linked dexmedetomidine’s neuroprotective properties with its modulation of neuroinflammation, apoptosis, oxidative stress, and synaptic plasticity via the α2-adrenergic receptor, dependently or independently. By reviewing recent advances and preclinical and clinical evidence on the neuroprotective effects of dexmedetomidine, we hope to provide a complete understanding of the above mechanism and provide insights into the potential efficacy of this agent in clinical use for patients.

• apoptosis
• caspase 8
• dexmedetomidine
• excitatory amino acid transporter 3
• excitotoxic neurotransmitter
• focal adhesion kinase
• necrosis
• nerve injury
• neuroinflammation
• neuroprotection

• Child
• Dexmedetomidine
• Hypnotics and sedatives
• Magnetic resonance imaging

• Child
• Dexmedetomidine/adverse effects
• Humans
• Hypnotics and Sedatives/adverse effects
• Magnetic Resonance Imaging
• Midazolam
• Propofol

• delirium
• dexmedetomidine
• lung cancer
• male
• one-lung ventilation
• postoperative cognitive dysfunction

• dexmedetomidine
• non-cardiac surgery
• postoperative delirium

• Dexmedetomidine/therapeutic use
• Humans
• Aged
• Postoperative Complications/prevention & control
• Delirium/prevention & control
• Randomized Controlled Trials as Topic
• Emergence Delirium/prevention & control
• Emergence Delirium/epidemiology
• Hypnotics and Sedatives/therapeutic use
• Hypnotics and Sedatives/adverse effects
• Surgical Procedures, Operative/adverse effects

Coronary artery bypass grafting (CABG) surgery involves various noxious stimuli resulting in stress response, which in turn increases the risk of perioperative myocardial ischemia. The present study was conducted to evaluate the effect of dexmedetomidine on the attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery.

Sixty patients were randomized into two groups of 30 each. Group D patients received dexmedetomidine 1 μg/kg as loading dose over 10 min, followed by continuous infusion of 0.5 μg/kg/h. In group P, normal saline was infused as loading and maintenance dose at similar rate. Hemodynamic parameters, total induction dose of thiopentone, and adverse effects were recorded. Statistical analysis was performed using SPSS version 20.0. Chi-square test and ANNOVA test were used and P < 0.05 was considered significant.

The percentage increase in heart rate was significantly lesser in group D than group P after intubation (7.04% v/s 15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s 11.65%). Similarly increase in systolic, diastolic, and mean blood pressure were significantly lesser in group D than group P after intubation, skin incision, and sternotomy. There was a significant reduction of mean total of thiopentone in group D in comparison to group P. (1.16 mg/kg v/s 2.44 mg/kg) (P<0.001).

Dexmedetomidine resulted in significant attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery without significant adverse effects. It also significantly reduced the dose of thiopentone required for induction.

• Dexmedetomidine
• hemodynamic response
• intubation
• skin incision
• sternotomy

The present study with trial sequential analysis (TSA) was conducted to evaluate comprehensively the efficacy and safety of dexmedetomidine and midazolam in pediatric sedation, and to investigate whether the outcomes achieved the required information size to draw the conclusions.

PubMed, Embase, and Cochrane Library were searched from inception to October 2019. All randomized controlled trials used dexmedetomidine and midazolam in pediatric sedation were enrolled. Sedative efficacy, postoperative analgesic effect, and incidence of emergence agitation were considered as the co‐primary outcomes. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was applied to rate the quality of evidences.

We acquired data from 34 studies involving 2281 pediatric patients. The results indicated that administration of dexmedetomidine was associated with less incidence of emergence agitation (RR = 0.78, with 95% CI [0.65, 0.92]) and more satisfactory sedation at parental separation (RR = 0.31, with 95% CI [0.24, 0.41]) compared to midazolam, and the current sample sizes were sufficient with unnecessary further trials. Two groups did not differ significantly in sedation level at mask induction (RR = 0.86, with 95% CI [0.74, 1.00]). And using of dexmedetomidine was associated with less incidence of postoperative analgesic rescue (RR = 0.57, with 95% CI [0.35, 0.93]), but the number of patients was too few to achieve the required information size and to draw reliable conclusions. Premedication of dexmedetomidine was associated with significant less value of SBP, heart rate, increased incidence of bradycardia, and a lower rate of shivering. And there were no differences about onset of sedation and recovery time between two groups.

Given that more satisfactory sedation at separation from parents and less incidence of emergence agitation, dexmedetomidine is preferred for pediatric sedation. However, compared with midazolam, the superiority of dexmedetomidine in providing adequate sedation at mask induction and postoperative analgesic effects has not yet been defined.

• dexmedetomidine
• meta-analysis
• midazolam
• pediatrics
• sedation

• Aggression
• agitation
• antipsychotics
• dexmedetomidine
• intranasal olanzapine
• mania
• psychosis
• schizophrenia

Effectiveness of controlled hypotension has been proven in alleviating intraoperative bleeding. Many recent studies emphasized the efficacy of dexmedetomidine and magnesium in providing controlled hypotension during various surgeries. The present meta-analysis of randomized controlled trials (RCTs) was performed to evaluate comprehensively the effects and safety of these two medications.

Literature search was performed in four databases from inception to April 2019. All RCTs that used dexmedetomidine and magnesium as hypotensive agents were enrolled. The outcomes contained bleeding condition of surgical site, hemodynamic parameters, duration of surgeries, number of patients requiring opioid/analgesia administration, recovery period, and adverse events emerged during surgeries.

Ten studies with 663 patients met with our inclusion criteria. The results indicated that both bleeding score and values of mean arterial pressure (MAP) and heart rate (HR) were significantly lower in patients receiving dexmedetomidine (SMD 1.65 with 95% CI [0.90,2.41], P<0.00001) compared to the patients receiving magnesium. The effect in decreasing the necessity of using opioid/analgesia was affirmative in dexmedetomidine group (29.13% with magnesium vs 10.78% with dexmedetomidine), and the condition was more favorable in magnesium group in reducing recovery period (SMD -1.98 with 95% CI [-4.27,0.30], P = 0.09). Compared with magnesium, using of dexmedetomidine was associated with higher incidence of bradycardia but lower incidence of nausea and vomiting.

Compared with magnesium, dexmedetomidine is more effective to provide promising surgical field condition, favorable controlled hypotension, and less necessity of opioid or analgesia administration. But long recovery period and high-probability bradycardia should be deliberated.

• Databases, Factual
• Dexmedetomidine/adverse effects
• Dexmedetomidine/therapeutic use
• Humans
• Hypotension/drug therapy
• Hypotension/physiopathology
• Magnesium Sulfate/adverse effects
• Magnesium Sulfate/therapeutic use
• Randomized Controlled Trials as Topic
• Surgical Procedures, Operative

• Dexmedetomidine
• endovenous thermal ablation
• varicose vein

• Agitação ao despertar
• Amigdalectomia
• Children
• Crianças
• Dexmedetomidina transmucosa oral
• Emergence agitation
• Oral transmucosal buccal dexmedetomidine
• Tonsillectomy

Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia.

Ninety patients aged (3–6 years), ASA I‒II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 µg.kg⁻¹ (Group DEX I), 1 µg.kg⁻¹ (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects.

The patients’ demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p = 0.007), 10 minutes (p = 0.034), 30 minutes (p = 0.022), 45 minutes (p = 0.034) and 60 minutes (p = 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p = 0.011), 10 minutes (p = 0.037) and 30 minutes (p = 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 min (p = 0.020), and lower mean arterial pressure at 30 minutes, (p = 0.040), 45 minutes (p = 0.002) and 60 minutes (p = 0.006) with no significant differences between groups in other time points.

This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo.

Clinical Trials.gov trial registry: NCT02720705.

• Aging
• Anesthesiology
• Elderly
• Geriatric
• Pharmacodynamic
• Pharmacokinetic
• Pharmacology
• Physiology

• Aged
• Aged, 80 and over
• Drug Therapy/trends
• Geriatrics/trends
• Humans
• Pharmaceutical Preparations/administration & dosage
• Pharmacokinetics
• Pharmacology/trends
• Population Dynamics

Background: Dexmedetomidine is widely used for conscious sedation in patients undergoing lower-extremity surgery under regional anesthesia. We evaluated the postoperative analgesic effects of intravenous dexmedetomidine given during ankle surgery under spinal anesthesia.

Methods: Forty-three participants underwent repair of lateral angle ligaments under spinal anesthesia. For sedation during surgery, participants were allocated to a dexmedetomidine group (n=22) that received a loading dose of 1 mcg.kg⁻¹ over 10 min, followed by a maintenance dose of 0.2–0.7 μg.kg⁻¹.h⁻¹; and a propofol group (n=21) that received an effective site concentration of 0.5–2.0 μg.mL⁻¹ via target-controlled infusion. The primary outcome was the postoperative, cumulative, intravenous (IV) morphine equivalent dose delivered via IV patient-controlled anesthesia (PCA) and rescue analgesic consumption in the first 24 h after surgery. We recorded sensory and motor block durations.

Results: The postoperative IV morphine equivalent dose was 14.5 mg (0.75–31.75 mg) in the dexmedetomidine group compared to 48.0 mg (31.5–92.5 mg) in the propofol group (median difference, 33.2 mg; 95% confidence interval, 21.0–54.8 mg; P<0.001). The time to the first complaint of surgical site pain was significantly prolonged in the dexmedetomidine group (P<0.001), but the duration of motor block was comparable between the two groups (P=0.55).

Conclusion: IV dexmedetomidine given as a sedative during ankle surgery under spinal anesthesia reduced postoperative opioid consumption in the first 24 h. Thus, intraoperative dexmedetomidine is a versatile sedative adjunct.

Level of evidence: Level I, prospective randomized trial.

• ankle surgery
• dexmedetomidine
• postoperative analgesia
• spinal anesthesia