Evaluating the Use of Dexmedetomidine in Neurocritical Care Patients

Dexmedetomidine is a highly selective alpha(2)-adrenoreceptor agonist that produces dose-dependent sedation, anxiolysis, and analgesia without respiratory depression. Dexmedetomidine has been used in critically ill medical, surgical, and pediatric patients, as an adjunct to sedation and/or for treating drug or alcohol withdrawal. Information regarding the dosing and utilization of dexmedetomidine has been derived primarily from studies in critically ill patients in the medical intensive care unit. There has been no study designed specifically to evaluate dexmedetomidine for these therapeutic uses in the neurocritical care population. The primary and secondary objectives were to evaluate the starting dose of dexmedetomidine for neurocritical care patients and to assess the effect on hemodynamic parameters, respectively. This was a prospective, observational study conducted from October 2007 to March 2008. Patients were included if they were admitted to the Neuro-Intensive Care Unit and received dexmedetomidine infusion. Six patients met the criteria for the study. The mean initial dexmedetomidine infusion rate and mean maximum infusion rate were 0.67 +/- A 0.2 and 1.3 +/- A 0.5 mcg/kg/h, respectively. The mean duration of dexmedetomidine infusion was 66 +/- A 10 h. Two patients (33%) experienced a significant change in mean heart rate and systolic blood pressure after starting dexmedetomidine infusion. Neurocritically ill patients may require high doses of dexmedetomidine to achieve desired levels of sedation. The high rates and long duration of dexmedetomidine infusion had a statistically, but not clinically, significant impact on hemodynamic parameters.