• Dexmedetomidine
• aortic dissection
• cardiac surgery
• postoperative delirium (POD)

• Dexmedetomidine
• IL-6
• Inflammatory cytokines
• Septic shock
• TNF-α

• Humans
• Dexmedetomidine/therapeutic use
• Dexmedetomidine/administration & dosage
• Shock, Septic/drug therapy
• Shock, Septic/blood
• Male
• Female
• Middle Aged
• Hypnotics and Sedatives/therapeutic use
• Hypnotics and Sedatives/administration & dosage
• Aged
• Norepinephrine/blood
• Treatment Outcome
• Biomarkers/blood
• Midazolam/therapeutic use
• Midazolam/administration & dosage
• Morphine/therapeutic use
• Morphine/administration & dosage
• Tumor Necrosis Factor-alpha/blood
• Interleukin-6/blood
• Adult
• Inflammation Mediators/blood

• CiteSpace
• bibliometric analysis
• delirium
• dexmedetomidine
• opioid-free anesthesia

• Dexmedetomidine
• Bibliometrics
• Humans
• Hypnotics and Sedatives
• Adrenergic alpha-2 Receptor Agonists/therapeutic use
• Animals

• Shandong Provincial Key Research and Development Project
• Shandong Provincial Natural Science Foundation
• Analgesia and Sedation-Special Foundation for Anesthesia Optimization of Shandong Medical Association
• 2023 Qilu medical characteristics undergraduate education teaching research project-Shandong University

• closed-loop acoustic stimulation
• dexmedetomidine
• electroencephalography
• sedation
• sleep
• slow waves

• K01 MH128663 NIMH NIH HHS
• K08 NS109292 NINDS NIH HHS
• R03 AG082988 NIA NIH HHS

• Dexmedetomidine/adverse effects
• Dexmedetomidine/therapeutic use
• Humans
• Infant, Newborn
• Hypnotics and Sedatives/adverse effects
• Hypnotics and Sedatives/therapeutic use
• Hypnotics and Sedatives/administration & dosage
• Pain Management/methods
• Analgesics, Non-Narcotic/adverse effects
• Analgesics, Non-Narcotic/therapeutic use
• Respiration, Artificial

• anesthetic neurotoxicity
• dexmedetomidine
• neuroplasticity
• neuroprotection
• postoperative delirium

• PRD 12-2017-I Hôpitaux Universitaires de Genève
• PC 04/17 SAMW

• conscious sedation
• dexmedetomidine
• hypnotics and sedatives
• pain
• palliative care
• refractory symptoms

• agitation
• alpha-2 agonist
• delirium
• guanfacine
• hyperactive delirium
• mixed delirium
• opioid

• burns
• delirium
• dexmeditomidine
• mechanical ventilation
• sedation

• adverse effect
• dexmedetomidine
• drug fever
• naranjo scale
• sedation
• ventilated

To assess the antiarrhythmic properties of dexmedetomidine in patients in the intensive care unit.

A literature review was conducted with Ovid MEDLINE (R), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, and Scopus. Study Selection. Randomized controlled trials were included, examining the incidence of ventricular arrhythmias, ventricular tachycardia, or ventricular fibrillation with dexmedetomidine compared to placebo or an alternative sedative agent. For each publication that met the selection criteria, the patient demographics, incidence of arrhythmias, mortality, and adverse events were collected. Data extraction was carried out by two authors independently.

We identified 6 out of 126 studies that met the selection criteria for our meta-analysis, all of which focused on the perioperative cardiac surgery period. Patients receiving dexmedetomidine demonstrated a significant reduction of the overall incidence of ventricular arrhythmias (RR 0.35, 95% CI 0.16, 0.76). In particular, dexmedetomidine significantly decreased the risk of ventricular tachycardia compared with control (RR 0.25, 95% CI 0.08, 0.80, I² 0%). Regarding adverse events, dexmedetomidine significantly increased the frequency of bradycardia (RR 2.78 95% CI 2.00, 3.87). However, there was no significant difference in mortality (RR 0.59 95% CI 0.12, 3.02).

From this meta-analysis, we report a decreased incidence of ventricular tachycardia with dexmedetomidine in critically ill patients. This result favors the use of dexmedetomidine for its antiarrhythmic properties.

• Delirium
• Dexmedetomidine
• Intensive care unit
• Invasive mechanical ventilation
• Sedation

• dexmedetomidine
• elderly
• interventional radiology
• lymphangiography
• procedural sedation
• thoracic duct embolization

• Dexmedetomidine
• pediatric respiratory failure
• propofol

• Abdominal surgery
• Dexmedetomidine
• General anesthesia
• Midazolam
• Propofol
• Sedation

• COVID-19
• analgesia
• management
• sedation
• withdrawal

In critically ill mechanically ventilated children, midazolam is used first line for sedation, however its exact sedative effects have been difficult to quantify. In this analysis, we use parametric time-to-event (PTTE) analysis to quantify the effects of midazolam in critically ill children.

In the PTTE analysis, data was analyzed from a published study in mechanically ventilated children in which blinded midazolam or placebo infusions were administered during a sedation interruption phase until, based on COMFORT-B and NISS scores, patients became undersedated and unblinded midazolam was restarted. Using NONMEM® v.7.4.3., restart of unblinded midazolam was analysed as event. Patients in the trial were divided into internal and external validation cohorts prior to analysis.

Data contained 138 events from 79 individuals (37 blinded midazolam; 42 blinded placebo). In the PTTE model, the baseline hazard was best described by a constant function. Midazolam reduced the hazard for restart of unblinded midazolam due to undersedation by 51%. In the blinded midazolam group, time to midazolam restart was 26 h versus 58 h in patients with low versus high disease severity upon admission (PRISM II < 10 versus > 21), respectively. For blinded placebo, these times were 14 h and 33 h, respectively. The model performed well in an external validation with 42 individuals.

The PTTE analysis effectively quantified the effect of midazolam in prolonging sedation and also the influence of disease severity on sedation in mechanically ventilated critically ill children, and provides a valuable tool to quantify the effect of sedatives.

Clinical trial number and registry URL: Netherlands Trial Register, Trial NL1913 (NTR2030), date registered 28 September 2009 https://www.trialregister.nl/trial/1913.

The online version contains supplementary material available at 10.1007/s11095-021-03113-w.

• critical care
• paediatrics
• pharmacodynamics

Delirium is an acute cognitive disorder that presents with fluctuation in cognition, apathy, and non-organized thinking, resulting in increased morbidity, mortality, intensive care unit (ICU) stay, and total healthcare costs. In patients undergoing cardiac surgery, delirium also increases the risk of postoperative complications, such as respiratory insufficiency, sternum instability, and need for re-operation of the sternum. This study aims to understand the incidence of delirium in patients after cardiac surgery in patients sedated with remimazolam besylate versus propofol.

In this prospective, double-blind, randomized controlled clinical trial, we aim to recruit 200 patients undergoing cardiac surgery between January 1, 2021, and December 31, 2021, who will be randomized to receive either remimazolam besylate or propofol infusions postoperatively, until they are extubated. The primary outcome is the incidence of delirium within 5 days after surgery. Secondary outcomes include the time of delirium onset, duration of delirium, ICU length of stay, hospital length of stay, and mechanical ventilation time.

The key objective of this study is to assess whether remimazolam besylate reduces the incidence of delirium in patients after cardiac surgery compared to propofol sedation. In this preliminary randomized controlled clinical trial, we will test the hypothesis that the use of remimazolam besylate lowers the incidence of delirium when compared to propofol in patients undergoing cardiac surgery.

chictr.org.cn ChiCTR2000038976. Registered on October 11, 2020

• Cardiac surgery
• Delirium
• Propofol
• Remimazolam besylate

• dexmedetomidine
• mechanical ventilation
• randomized controlled trials

• Analgesics, Non-Narcotic/adverse effects
• Analgesics, Non-Narcotic/therapeutic use
• Dexmedetomidine/adverse effects
• Dexmedetomidine/therapeutic use
• Humans
• Mortality/trends
• Randomized Controlled Trials as Topic/methods
• Respiration, Artificial/adverse effects
• Respiration, Artificial/mortality
• Respiration, Artificial/trends

• Anesthesia
• Aortic stenosis
• Dexmedetomidine
• Sedation
• TAVI

• Analgesics/therapeutic use
• Clonidine/therapeutic use
• Humans
• Infant, Newborn
• Pain, Postoperative/prevention & control
• Pain, Procedural/drug therapy
• Pain, Procedural/prevention & control

Because of its analgesic and light sedative properties, the highly selective alpha-2 adrenergic receptor agonist dexmedetomidine (DEX) has been suggested for the treatment of septic patients, but its effect on the duration of mechanical ventilation remains unclear. The present study was conducted to review the extant literature in DEX and determine its influence on ventilation time in adult septic patients.

Databases of PubMed, Cochrane, and EMBASE were applied till 20th January 2019 without language restriction. The searching strategy as following: sepsis OR septic AND mechanical ventilation AND dexmedetomidine. Two authors screened titles, abstracts, and even articles to meet the including criterion independently. In addition, references of related articles or reviews were also referred. Data was recorded in a table and analyzed using the software of Review Manager 5.0.

Four studies with a total of 349 patients were included. Three trials with 267 patients revealed the effect of DEX on duration of mechanical ventilation, two trials with 264 patients on ventilator-free days and four trials with 334 patients on 28-day mortality. The analyzed results indicated that DEX was not associated with significantly different durations of mechanical ventilation (MD 0.65, 95% CI, − 0.13 to 1.42, P = 0.10). However, there were significant differences in ventilator-free days (MD 3.57, 95% CI, 0.26 to 6.89, P = 0.03) and 28-day mortality (RR 0.61, 95% CI, 0.49 to 0.94, P = 0.02) in the septic patients.

Administration of DEX for sedation in septic patients was not associated with the duration of mechanical ventilation, but it increased the ventilator-free days and reduced 28-day mortality.

• Dexmedetomidine
• Duration of mechanical ventilation
• Sepsis
• Systematic review and meta-analysis

The α2 agonists, dexmedetomidine and clonidine, are used as sedative drugs during critical illness. These drugs may have anti-inflammatory effects, which might be relevant to critical illness, but a systematic review of published literature has not been published. We reviewed animal and human studies relevant to critical illness to summarise the evidence for an anti-inflammatory effect from α2 agonists.

We searched PubMed, the Cochrane library, and Medline. Animal and human studies published in English were included. Broad search terms were used: dexmedetomidine or clonidine, sepsis, and inflammation. Reference lists were screened for additional publications. Titles and abstracts were screened independently by two reviewers and full-text articles obtained for potentially eligible studies. Data extraction used a bespoke template given study diversity, and quality assessment was qualitative.

Study diversity meant meta-analysis was not feasible so descriptive synthesis was undertaken. We identified 30 animal studies (caecal ligation/puncture (9), lipopolysaccharide (14), acute lung injury (5), and ischaemia-reperfusion syndrome (5)), and 9 human studies. Most animal (26 dexmedetomidine, 4 clonidine) and all human studies used dexmedetomidine. In animal studies, α2 agonists reduced serum and/or tissue TNFα (20 studies), IL-6 (17 studies), IL-1β (7 studies), NFκB (6 studies), TLR4 (6 studies), and a range of other mediators. Timing and doses varied widely, but in many cases were not directly relevant to human sedation use. In human studies, dexmedetomidine reduced CRP (4 studies), TNFα (5 studies), IL-6 (6 studies), IL-1β (3 studies), and altered several other mediators. Most studies were small and low quality. No studies related effects to clinical outcomes.

Evidence supports potential anti-inflammatory effects from α2 agonists, but the relevance to clinically important outcomes is uncertain. Further work should explore whether dose relationships with inflammation and clinical outcomes are present which might be separate from sedation-mediated effects.

• Clonidine
• Critical care
• Dexmedetomidine
• Immune system
• Inflammation
• Sepsis

Surgery and diseases modify inflammatory responses and the immune system. Anesthetic agents also have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses. The aim of this study was to assess how single-drug dexmedetomidine and propofol anesthesia without any surgical intervention alter acute immunological biomarkers in healthy subjects.

Thirty-five healthy, young male subjects were anesthetized using increasing concentrations of dexmedetomidine (n = 18) or propofol (n = 17) until loss of responsiveness (LOR) was detected. The treatment allocation was randomized. Multi-parametric immunoassays for the detection of 48 cytokines, chemokines and growth factors were used. Concentrations were determined at baseline and at the highest drug concentration for each subject.

The changes in the concentration of eotaxin (decrease after dexmedetomidine) and platelet-derived growth factor (PDGF, increase after propofol) were statistically significantly different between the groups. Significant changes were detected within both groups; the concentrations of monocyte chemotactic protein 1, chemokine ligand 27 and macrophage migration inhibitory factor were lower in both groups after the drug administration. Dexmedetomidine decreased the concentration of eotaxin, interleukin-18, interleukin-2Rα, stem cell factor, stem cell growth factor and vascular endothelial growth factor, and propofol decreased significantly the levels of hepatocyte growth factor, IFN-γ-induced protein 10 and monokine induced by IFN-γ, and increased the levels of interleukin-17, interleukin-5, interleukin-7 and PDGF.

Dexmedetomidine seemed to have an immunosuppressive effect on the immune system whereas propofol seemed to induce mixed pro- and anti-inflammatory effects on the immune system. The choice of anesthetic agent could be relevant when treating patients with compromised immunological defense mechanisms.

Before subject enrollment, the study was registered in the European Clinical Trials database (EudraCT number 2013–001496-21, The Neural Mechanisms of Anesthesia and Human Consciousness) and in ClinicalTrials.gov (Principal Investigator: Harry Scheinin, number NCT01889004, The Neural Mechanisms of Anesthesia and Human Consciousness, Part 2, on the 23rd of June 2013).

• Cytokines
• Dexmedetomidine
• Immunology
• Immunosuppression
• Propofol

• Antipsychotic Agents/therapeutic use
• Critical Illness
• Delirium/drug therapy
• Humans
• Network Meta-Analysis
• Randomized Controlled Trials as Topic

• CIHR

Preclinical studies support investigation of focused ultrasound for breakdown of cerebral pathologies in neurodegenerative conditions including Alzheimer's disease (AD) and Parkinson's disease (PD).

A focused transcranial Doppler device with probes (2 MHz, 520 mW/cm²) affixed bilaterally was used to target the hippocampus (AD) or substantia nigra (PD) with functional magnetic resonance imaging navigation for enhanced plaque removal. A total of 22 patients (n = 11 AD, n = 11 PD) underwent 8 consecutive, weekly, 1-hour treatments wherein sleep was encouraged naturally or pharmacologically. Cognitive and motor functioning assessment was carried out using standardized evaluations at baseline and conclusion.

Of all, 62.5% of patients had one or more improved cognitive scores without data incongruence, 87% had stable or improved fine motor scores, and 87.5% had stable or improved gross motor scores. No adverse events were reported.

The safety of focused transcranial Doppler and possible enhancement in patient functioning were suggested by outcome data.

• ASL
• Alzheimer's
• Cognition
• Dementia
• Parkinson's
• Sleep
• Ultrasound

• Analgesics
• intensive care
• mechanical ventilation
• sedation scale
• sedatives

• Anesthesia/methods
• Anesthesia/trends
• Confidence Intervals
• Conscious Sedation/methods
• Conscious Sedation/trends
• Dexmedetomidine/administration & dosage
• Diagnostic Tests, Routine
• Female
• Health Care Surveys
• Humans
• Hypnotics and Sedatives/administration & dosage
• Intensive Care Units/statistics & numerical data
• Male
• Midazolam/administration & dosage
• Propofol/administration & dosage
• Quality Improvement
• Registries
• Statistics, Nonparametric
• Sweden

Delirium is the most frequent manifestation of acute brain dysfunction in intensive care unit (ICU). Although antipsychotics are widely used to treat this serious complication, recent evidence has emphasized that these agents did not reduce ICU delirium (ICU-D) prevalence and did not improve survival, length of ICU or hospital stay after its occurrence. Of note, no pharmacological strategy to prevent or treat delirium has been identified, so far. In this scenario, new scientific evidences are urgently needed. Investigations on specific ICU-D subgroups, or focused on different clinical settings, and studies on medications other than antipsychotics, such as dexmedetomidine or melatonin, may represent interesting fields of research. In the meantime, because there is some evidence that ICU-D can be effectively prevented, the literature suggests strengthening all the strategies aimed at prevention through no-pharmacological approaches mostly focused on the correction of risk factors. The more appropriate strategy useful to treat established delirium remains the use of antipsychotics managed by choosing the right doses after a careful case-by-case analysis. While the evidence regarding the use of dexmedetomidine is still conflicting and sparse, this drug offers interesting perspectives for both ICU-D prevention and treatment. This paper aims to provide an overview of current pharmacological approaches of evidence-based medicine practice. The state of the art of the on-going clinical research on the topic and perspectives for future research are also addressed.

• Delirium
• Intensive care
• Haloperidol
• Antipsychotic agents
• Major tranquilizers
• Cognitive decline
• Dexmedetomidine

• 躁动
• 机械通气
• 右美托咪定
• 儿童
• agitation
• mechanical ventilation
• dexmedetomidine
• child

• Child
• Dexmedetomidine
• Humans
• Hypnotics and Sedatives
• Prospective Studies
• Respiration, Artificial
• Ventilator Weaning

• 躁动
• 机械通气
• 右美托咪定
• 儿童
• agitation
• mechanical ventilation
• dexmedetomidine
• child

• Child
• Dexmedetomidine
• Humans
• Hypnotics and Sedatives
• Prospective Studies
• Respiration, Artificial
• Ventilator Weaning

• Sedation
• capnography
• dexmedetomidine
• monitoring
• procedure
• remifentanil

• Analgesics/pharmacology
• Conscious Sedation/methods
• Humans
• Hypnotics and Sedatives/pharmacology
• Monitoring, Physiologic
• Operating Rooms

• Dexmedetomidine
• MIMIC-III database
• midazolam
• mortality
• propensity score matching (PSM)
• propofol

• adult intensive & critical care
• psychiatry

• Conscious Sedation
• Deep Sedation
• Delirium/drug therapy
• Delirium/mortality
• Dexmedetomidine/therapeutic use
• Humans
• Hypnotics and Sedatives/therapeutic use
• Intensive Care Units
• Meta-Analysis as Topic
• Research Design
• Systematic Reviews as Topic

• anesthesia
• cardiac surgery
• dexmedetomidine
• elderly patients
• postoperative delirium

• analgesics
• chronic pain
• critical care
• opioids
• pain

• clinical pharmacology
• quality in health care

• Cognition
• Critical Care/methods
• Delirium/drug therapy
• Delirium/prevention & control
• Humans
• Intensive Care Units
• Meta-Analysis as Topic
• Mortality
• Quality of Life
• Review Literature as Topic

• Innovation Fund Denmark

Awake fiberoptic intubation (AFOI) is the gold standard technique for managing patients with anticipated difficult airway. Conscious sedation is desirable, not only to make the procedure more tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Ideal sedation regime for AFOI should provide comfort, cooperation, hemodynamic stability, and amnesia along with maintenance of spontaneous respiration. Several sedative agents have been assessed over the past two decades for this purpose but α2 agonists appear to be the favorable choice owing to its sedative, analgesic, amnestic, and sympatholytic properties along with good hemodynamic profile.

The present study has been aimed to recognize the characteristics of dexmedetomidine, clonidine, and midazolam and to compare their efficacy in providing optimal intubating conditions as well as hemodynamic stability during AFOI.

A prospective double-blind randomized study done in tertiary care hospital.

Sixty patients of American Society of Anesthesiologists physical status Classes I and II aged 18–60 years with anticipated difficult airway were randomly allocated into three groups. All the patients received injection midazolam bolus followed by sedation infusion of midazolam, dexmedetomidine, and clonidine according to the allocated group. Primary outcome includes the time to achieve Ramsay Sedation Score (RSS) ≥2, time taken in intubation, intubation score, comfort score for fiberoptic insertion and intubation, and patient tolerance after intubation. The secondary outcome was hemodynamic, and respiratory variables include changes in heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO₂), and respiratory rate during the procedure.

All data were recorded, summarized, tabulated, and statistically analyzed using SPSS 16.0 version (Chicago, Inc., USA). The data were presented in mean ± standard deviation. P < 0.05 was considered as statistically significant.

All the three groups were comparable in terms of demographic profile. Time to achieve RSS ≥2 and mean intubation time was significantly less in Groups D and C as compared to Group M (P < 0.001). Among groups, Group D took least time to achieve RSS ≥2 (5.53 ± 0.74) and mean intubation time (4.53 ± 0.91). Similarly, overall intubation score, comfort, and patient tolerance score were significantly more in Group M as compared to Groups D and C (P < 0.001). Among the groups, Group D achieved least intubation score (3.80 ± 0.67) and comfort score (2.53 ± 0.74). Although Groups D and C have a lower mean HR and MAP during the procedure and intubation compared to Group M, the incidence of SpO₂ is most frequent with clonidine.

Patients who received α2 agonist were calmer and cooperative with less pain and discomfort than the patients who received midazolam. Dexmedetomidine allows better endurance, stable hemodynamics, and patent airway as compared to clonidine.

• Awake fiberoptic intubation
• clonidine
• conscious sedation
• dexmedetomidine
• midazolam

• dexmedetomidine
• percutaneous nephrolithotomy lithotripsy
• systemic inflammatory response syndrome

• Administration, Intravenous
• Adrenergic alpha-2 Receptor Agonists/administration & dosage
• Adult
• Dexmedetomidine/administration & dosage
• Double-Blind Method
• Female
• Humans
• Interleukin-6/blood
• Length of Stay/economics
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Nephrolithotomy, Percutaneous/adverse effects
• Perioperative Care/methods
• Postoperative Complications/epidemiology
• Postoperative Period
• Systemic Inflammatory Response Syndrome/epidemiology
• Systemic Inflammatory Response Syndrome/prevention & control
• Treatment Outcome
• Tumor Necrosis Factor-alpha/blood

• Technology Planning Project of Guangdong Province, China
• Sun Yat-Sen University Clinical Research 5010 Program, China

• Delirium
• Dexmedetomidine
• Meta-analysis

• Dexmedetomidine
• Multiparameter Intelligent Monitoring in Intensive Care III database (MIMIC-III database)
• mortality
• rebound effect

Dexmedetomidine is an α₂-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α₂-receptors with an α₂:α₁ ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α₂-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.

• critical care
• delirium
• intensive cardiac care unit