Dexmedetomidine in intensive care unit: a study of hemodynamic changes

BACKGROUND: Dexmedetomidine is a potent new alpha-2 adrenoceptor agonist with an alpha-2 to alpha- ratio more than 7 times that of clonidine. Its potent sedative, analgesic and sympatholytic effects blunt the cardiovascular responses (hypertension, tachycardia) without unexpected toxicity. Many reports confirmed its pharmacological properties if given by infusion. Recent report confirmed favorable non-depressant effect on respiration and blood gases. SETTING: ICU patients at King Khalid University Hospital. PATIENTS AND METHOD: Open label clinical evaluation on ten surgical patient ASA I class received dexmeditomidine infusion to the sedative effect level of Ramsy scale of 3 for ventilated patients and 2 for spontaneously breathing patient. The clinical observation and analgesic requirement as well as the hemodynamic parameters and hemoglobin oxygen saturation were observed for the period of ventilation and weaning till discharge from the ICU. These records were subjected to paired t test for values measured at preinfusion period compared to 10 minutes and 6 hours measurement after infusion. RESULTS: The study confirmed the previous findings of previous reports regarding the cardiovascular stability and non depressive effect on respiration. It also confirmed the sparing effect on the use of analgesics which indicates its analgesic effect. The sedation quality is unique in that the patient is easily arousable. This was reported favorably by the nursing staff. Bradycardia was observed in one patient who was treated effectively by stopping the infusion. CONCLUSION: We concluded that dexmedetomidine is useful sedative agent with analgesic properties which reduce the analgesic requirement of the patient. The patient were ventilated, weaned, then breathed spontaneously in a satisfactory manner.