Anest. intenziv. Med. 2017;28(2):114-126

Dexmedetomidine and its use in anaesthesia and intensive careSpecial article

B. Bilý^1,*, F. Sabol¹, P. Török², P. Čandík²

¹ Klinika srdcovej chirurgie Lekárskej fakulty Univerzity Pavla Jozefa Šafárika a VÚSCH a. s., Košice

² Klinika anestéziológie a intenzívnej medicíny Lekárskej fakulty Univerzity Pavla Jozefa Šafárika a VÚSCH a. s., Košice

Dexmedetomidine is a potent, highly selective and specific α₂-adrenergic agonist with sedative, analgesic and sympatholytic effect. It is characterized by high selectivity of α₂:α₁ at a ratio of 1600:1. Dexmedetomidine acts through the G-protein coupled receptor, which induces inhibition of adenylate cyclase, which in turn leads to a decrease in cAMP. The result is inhibition of the release of norepinephrine, which leads to a decrease of excitation in particular in the locus coeruleus. It also reduces the release of norepinephrine into the systemic circulation, thereby improving the haemodynamic stability, and has a positive effect on the myocardial oxygen supply, which contributes to the protection of the myocardium. α₂-adrenergic agonists alleviate the stress response of the organism to the surgical intervention, thus during heart surgery they reduce the number of ischemic episodes and their administration is associated with a decreased risk of myocardial infarction. By its anti-inflammatory effect, stabilization of the sympathetic nervous system and the mitigation of ischemia-reperfusion damage, dexmedetomidine is characterized by a protective effect on the function of the heart, brain, kidney and the immune system. Although dexmedetomidine has sedative, analgesic and anxiolytic effects, in contrast to other sedatives it does not cause respiratory depression and provides respiratory stability during anaesthesia. The primary site of action of α₂-adrenergic agonists is the locus coeruleus and not the cortex, like it is in the case of GABA-mimetics. The unusual subcortical form of sedation induced by dexmedetomidine is characterized by quickly and easily reached loss of consciousness, which resembles natural sleep.

Keywords: dexmedetomidine; α₂-adrenergic agonist; sedation; surgical trauma; cardiac surgery; cardio-protective effect

Received: October 10, 2016; Accepted: November 21, 2016; Published: April 1, 2017  Show citation