대한치과마취과학회지 (Journal of The Korean Dental Society of Anesthesiology)

  • 제13권4호
  • /
  • Pages.161-166
  • /
  • 2013
  • /
  • 1598-4044(pISSN)
  • /
  • 2383-7039(eISSN)
대한치과마취과학회 (The Korean Dental Society of Anesthsiology)
권호 표지

덱스메데토미딘의 임상적인 사용

Dexmedetomidine: Clinical use

  • 윤지영 (부산대학교 치의학전문대학원 치과마취통증학교실, 치의학연구소) ;
  • 김철홍 (부산대학교 치의학전문대학원 치과마취통증학교실, 치의학연구소)
  • Yoon, Ji Young (Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University, Dental Research Institute) ;
  • Kim, Cheul Hong (Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University, Dental Research Institute)
  • 투고 : 2013.12.18
  • 심사 : 2014.01.02
  • 발행 : 2013.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Dexmedetomidine is a potent alpha-2-adrenergic agonist, more selective than clonidine, with widespread actions on the mammalian brain. A large body of recent work supports its analgesia and sympatholytic properties. Dexmedetomidine is a useful medication with many clinical applications. The medication has shown efficacy in decreasing the need for opioids, benzodiazepines, propofol, and other sedative medications. Dexmedetomidine has been used effectively for sedation during invasive procedures and in the ICU. Short-term sedation has been shown to be safe in studies, although hypotension and bradycardia are the most significant side effects. Dexmedetomidine is emerging as an effective therapeutic agent in the management of a wide range of clinical conditions with an efficacious, safe profile.

키워드

참고문헌

  1. Kauppila T, Kemppainen P, Tanila H, Pertovaara A: Effect of systemic medetomidine, an alpha 2 adrenoceptor agonist, on experimental pain in humans. Anesthesiology 1991; 74: 3-8. https://doi.org/10.1097/00000542-199101000-00002
  2. Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al: Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia 1999; 54: 1136-42. https://doi.org/10.1046/j.1365-2044.1999.01114.x
  3. Kamibayashi T, Maze M: Clinical uses of alpha2 -adrenergic agonists. Anesthesiology 2000; 93: 1345-9. https://doi.org/10.1097/00000542-200011000-00030
  4. Khan ZP, Ferguson CN, Jones RM: Alpha-2 and imida zoline receptor agonists. their pharmacology and therapeutic role. Anaesthesia 1999; 54: 146-65. https://doi.org/10.1046/j.1365-2044.1999.00659.x
  5. Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M: The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98: 428-36. https://doi.org/10.1097/00000542-200302000-00024
  6. Aantaa R, Scheinin M: Alpha 2-adrenergic agents in anaesthesia. Acta Anaesthesiol Scand 1993; 37: 433-48. https://doi.org/10.1111/j.1399-6576.1993.tb03743.x
  7. Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, et al: Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119-41. https://doi.org/10.1097/00003246-200201000-00020
  8. Panzer O, Moitra V, Sladen RN: Pharmacology of sedative-analgesic agents: Dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Anesthesiol Clin 2011; 29: 587,605, vii.
  9. Potts AL, Anderson BJ, Warman GR, Lerman J, Diaz SM, Vilo S: Dexmedetomidine pharmacokinetics in pediatric intensive care--a pooled analysis. Paediatr Anaesth 2009; 19: 1119-29. https://doi.org/10.1111/j.1460-9592.2009.03133.x
  10. Drouot X, Cabello B, d'Ortho MP, Brochard L: Sleep in the intensive care unit. Sleep Med Rev 2008; 12: 391-403. https://doi.org/10.1016/j.smrv.2007.11.004
  11. Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, et al: Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003; 167: 708-15. https://doi.org/10.1164/rccm.2201090
  12. Brummett CM, Padda AK, Amodeo FS, Welch KB, Lydic R: Perineural dexmedetomidine added to ropivacaine causes a dose-dependent increase in the duration of thermal antinociception in sciatic nerve block in rat. Anesthesiology 2009; 111: 1111-9. https://doi.org/10.1097/ALN.0b013e3181bbcc26
  13. Roche Campo F, Drouot X, Thille AW, Galia F, Cabello B, d'Ortho MP, et al: Poor sleep quality is associated with late noninvasive ventilation failure in patients with acute hypercapnic respiratory failure. Crit Care Med 2010; 38: 477-85. https://doi.org/10.1097/CCM.0b013e3181bc8243
  14. Borgeat A, Aguirre J: Sedation and regional anesthesia. Curr Opin Anaesthesiol 2009; 22: 678-82. https://doi.org/10.1097/ACO.0b013e32832f3320
  15. Grant SA, Breslin DS, MacLeod DB, Gleason D, Martin G: Dexmedetomidine infusion for sedation during fiberoptic intubation: A report of three cases. J Clin Anesth 2004; 16: 124-6. https://doi.org/10.1016/j.jclinane.2003.05.010
  16. Koroglu A, Demirbilek S, Teksan H, Sagir O, But AK, Ersoy MO: Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: Preliminary results. Br J Anaesth 2005; 94: 821-4. https://doi.org/10.1093/bja/aei119
  17. Koroglu A, Teksan H, Sagir O, Yucel A, Toprak HI, Ersoy OM: A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg 2006; 103: 63,7, table of contents. https://doi.org/10.1213/01.ANE.0000219592.82598.AA
  18. Shukry M, Clyde MC, Kalarickal PL, Ramadhyani U: Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia? Paediatr Anaesth 2005; 15: 1098-104. https://doi.org/10.1111/j.1460-9592.2005.01660.x
  19. Ard J, Doyle W, Bekker A: Awake craniotomy with dexmedetomidine in pediatric patients. J Neurosurg Anesthesiol 2003; 15: 263-6. https://doi.org/10.1097/00008506-200307000-00015
  20. Shukry M, Ramadhyani U: Dexmedetomidine as the primary sedative agent for brain radiation therapy in a 21-month old child. Paediatr Anaesth 2005; 15: 241-2. https://doi.org/10.1111/j.1460-9592.2005.01418.x
  21. Anttila M, Penttila J, Helminen A, Vuorilehto L, Scheinin H: Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br J Clin Pharmacol 2003; 56: 691-3. https://doi.org/10.1046/j.1365-2125.2003.01944.x
  22. Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH: A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg 2007; 105: 374-80. https://doi.org/10.1213/01.ane.0000269488.06546.7c
  23. Herr DL, Sum-Ping ST, England M: ICU sedation after coronary artery bypass graft surgery: Dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth 2003; 17: 576-84. https://doi.org/10.1016/S1053-0770(03)00200-3
  24. Venn RM, Grounds RM: Comparison between dexmedetomidine and propofol for sedation in the intensive care unit: Patient and clinician perceptions. Br J Anaesth 2001; 87: 684-90. https://doi.org/10.1093/bja/87.5.684
  25. Elbaradie S, El Mahalawy FH, Solyman AH: Dexmedetomidine vs. propofol for short-term sedation of postoperative mechanically ventilated patients. J Egypt Natl Canc Inst 2004; 16: 153-8.
  26. Corbett SM, Rebuck JA, Greene CM, Callas PW, Neale BW, Healey MA, et al: Dexmedetomidine does not improve patient satisfaction when compared with propofol during mechanical ventilation. Crit Care Med 2005; 33: 940-5. https://doi.org/10.1097/01.CCM.0000162565.18193.E5
  27. Gerlach AT, Dasta JF: Dexmedetomidine: An updated review. Ann Pharmacother 2007; 41: 245-52. https://doi.org/10.1345/aph.1H314
  28. Lerch C, Park GR: Sedation and analgesia. Br Med Bull 1999; 55: 76-95. https://doi.org/10.1258/0007142991902303
  29. Ruesch S, Levy JH: Treatment of persistent tachycardia with dexmedetomidine during off-pump cardiac surgery. Anesth Analg 2002; 95: 316,8, table of contents.
  30. Ickeringill M, Shehabi Y, Adamson H, Ruettimann U: Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: Haemodynamic effects and efficacy. Anaesth Intensive Care 2004; 32: 741-5.
  31. Wijeysundera DN, Naik JS, Beattie WS: Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: A meta-analysis. Am J Med 2003; 114: 742-52. https://doi.org/10.1016/S0002-9343(03)00165-7
  32. Jalonen J, Hynynen M, Kuitunen A, Heikkila H, Perttila J, Salmenpera M, et al: Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology 1997; 86: 331-45. https://doi.org/10.1097/00000542-199702000-00009
  33. But AK, Ozgul U, Erdil F, Gulhas N, Toprak HI, Durmus M, et al: The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery. Acta Anaesthesiol Scand 2006; 50: 1207-12. https://doi.org/10.1111/j.1399-6576.2006.01136.x
  34. Frost EA, Booij LH: Anesthesia in the patient for awake craniotomy. Curr Opin Anaesthesiol 2007; 20: 331-5. https://doi.org/10.1097/ACO.0b013e328136c56f
  35. Mack PF, Perrine K, Kobylarz E, Schwartz TH, Lien CA: Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol 2004; 16: 20-5. https://doi.org/10.1097/00008506-200401000-00005