Información del artículo
RESUMEN
La dexmedetomidina se usó para sedación inicialmente en unidades de cuidados intensivos. Sin embargo, sus efectos sedantes, analgésicos y ansiolíticos sin alteración de la función ventilatoria, permiten ampliar su uso en cirugía como anestésico intravenoso. La literatura reporta su utilidad en poblaciones quirúrgicas definidas, pero aún faltan estudios que respalden su utilización en todos los escenarios de la anestesia total intravenosa (TIVA). El propósito de la actual revisión es describir el papel de la dexmedetomidina en la misma.
Materiales y métodosSe realizó la búsqueda de literatura en las bases de datos referenciales de PubMed, Medline, EMBASE, Cochrane y LILACS. Fue ampliada según la bibliografía encontrada en los artículos inicialmente revisados y analizados
Palabras clave::
Dexmedetomidina
anestesia intravenosa
receptores adrenérgicos alfa 2
agonistas adrenérgicos. (Fuente: DeCS, BIREME).
Key words:
Dexmedetomidine
anesthesia intravenous
receptors adrenergic alpha-2
adrenergic agonists. (Source: MeSH, NLM).
SUMMARY
Dexmedetomidine was used initially for sedation in intensive care units. However, because of its sedative, analgesic and anti-anxiety effects and the fact that it does not alter ventilatory function, its use may be expanded as an intravenous agent in surgery. There are reports in the literature about its effective use in specific surgical populations, although further studies are required in order to support its use in all situations where total intravenous anesthesia (TIVA) is applied. The purpose of this review is to describe the role of dexmedetomidine in this form of anesthesia.
Materials y methodsA literature search was conducted in PubMed, Medline, EMBASE, Cochrane and LILACS. The search was expanded based on the references found in the articles repor los autores; la búsqueda fue hecha bajo los términos MeSH incluidos en las palabras claves.
El Texto completo está disponible en PDF
REFERENCES
[1.]
A. Venegas Saavedra.
2 ed,
[2.]
R.D. Miller.
Anesthetic pharmacologic, Intravenous Anesthetics.
7ed,
[3.]
M.A. Ramsay, D.L. Luterman.
Dexmedetomidine as a total intravenous anesthetic agent.
Anesthesiology, 101 (2004), pp. 787-790
[4.]
O. Talke Pekka, E. Caldwell James, A. Richardson Charles, H. Kirkegaard-Nielsen, M. Stafford.
The effects of increasing plasma concentrations of dexmedetomidine in humans.
Anesthesiology, 93 (2000), pp. 382-394
[5.]
K. Popat, R. Purugganan, I. Malik.
Off-Label Uses of Dexmedetomidine.
Advances in Anesthesia Vol., 24 (2006), pp. 177-192
[6.]
Z.P. Khan, C.N. Ferguson, R.M. Jones.
Alpha-2 and imidazoline receptor agonists: their pharmacology and therapeutic role.
Anaesthesia, 54 (1999), pp. 146-165
[7.]
T. Kamibayashi, M. Maze.
Clinical uses of a2 adrenergic agonists.
Anesthesiology, 93 (2000), pp. 1345-1349
[8.]
J.D. Tobias.
Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology.
Pediatr Crit Care Med, 8 (2007), pp. 115-131
[9.]
M. Maze, W. Tranquilli.
Alpha-2 adrenoceptor agonists: defining the role in clinical anesthesia.
Anesthesiology, 74 (1991), pp. 581-605
[10.]
A. Bekker, V.S.B. Jorden.
Alpha-2 agonists in neuroanesthesia.
Seminars in anesthesia, perioperative medicine and pain, 3 (2004), pp. 181-191
[11.]
V. Yazbeck-karam, M. Aouad.
Perioperative uses of dexmedetomidine.
Middle East Journal of Anesthesiology, 6 (2006), pp. 1043-1058
[12.]
T.Z. Guo, J.Y. Jiang, A.E. Buttermann, M. Maze.
Dexmedetomidine injection into the locus ceruleus produces antinociception.
Anesthesiology, 84 (1996), pp. 873-881
[13.]
L.E. Nelson, J. Lu, T. Guo, C.B. Saper, N.P. Franks, M. Maze.
The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects.
Anesthesiology, 98 (2003), pp. 428-436
[14.]
C. Nacif-Coelho, C. Correa-Sales, L.L. Chang, M. Maze.
Perturbation of ion channel conductance alters the hypnotic response to the alpha 2-adrenergic agonist dexmedetomidine in the locus coeruleus of the rat.
Anesthesiology, 81 (1994), pp. 1527-1534
[15.]
R.M. Venn, C.J. Bradshaw, R. Spencer, D. Brealey, E. Caudwell, C. Naughton.
Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit.
Anaesthesia, 54 (1999), pp. 1136-1142
[16.]
R. Virtanen, J.M. Savola, V. Saano, L. Nyman.
Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist.
Eur J Pharmacol, 150 (1988), pp. 9-14
[17.]
R.M. Venn, M.D. Karol, R.M. Grounds.
Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive caret.
Br J Anaesth, 88 (2002), pp. 669-675
[18.]
J.B. Dyck, M. Maze, C. Haack, L. Vuorilehto, S.L. Shafer.
The pharmacokinetics and hemodynamic effects of intravenous and intramuscular dexmedetomidine hydrochloride in adult human volunteers.
Anesthesiology, 78 (1993), pp. 813-820
[19.]
A.M. De Wolf, R.J. Fragen, M.J. Avram, P.C. Fitzgerald, F. Rahimi-Danesh.
The pharmacokinetics of dexmedetomidine in volunteers with severe renal impairment.
Anesth Analg, 93 (2001), pp. 1205-1209
[20.]
J.B. Dyck, M. Maze, C. Haack, D.L. Azarnoff, L. Vuorilehto, S.L. Shafer.
Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers.
Anesthesiology, 78 (1993), pp. 821-828
[21.]
K. Engelhard, C. Werner, S. Kaspar, O. Mollenberg, M. Blobner, M. Bachl.
Effect of the alpha2-agonist dexmedetomidine on cerebral neurotransmitter concentrations during cerebral ischemia in rats.
Anesthesiology, 96 (2002), pp. 450-457
[22.]
R. Aantaa, A. Kallio, R. Virtanen.
Dexmedetomidine, a novel a2-adrenergic agonist: a review of its pharmacodynamic characteristics.
En: Drugs Future, 18 (1993), pp. 49-56
[23.]
E. Frangoulidou, R. Kuhlen, C. Marenghi.
Sedative agents and respiratory depression: a unique profile of dexmedetomidine.
pp. 40-50
[24.]
R.R. Riker, G.L. Fraser.
Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit.
Pharmacotherapy, 25 (2005), pp. 8S-18S
[25.]
C. Lerch, G.R. Park.
Sedation and analgesia.
En: BMJ, 55 (1999), pp. 76-95
[26.]
P. Pandharipande, B. Pun, D. Herr, M. Maze, T. Girard, R. Miller.
Effect of sedation with dexmedetomidine versus lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial.
JAMA, 298 (2007), pp. 2644-2664
[27.]
H.M. Willigers, F.W. Prinzen, P.M. Roekaerts, S. De Lange, M.E. Durieux.
Dexmedetomidine decreases perioperative myocardial lactate release in dogs.
Anesth Analg, 96 (2003), pp. 657-664
[28.]
P. Roekaerts, F. Prinzen, H. Willingers.
The effect of dexmedetomidine on systemic haemodynamics, regional myocardial function and blood flow during coronary artery stenosis in acute anaesthetized dogs.
J Cardiothorac Anesth, 8 (1994), pp. 58
[29.]
A.W. Wallace, D. Galindez, A. Salahieh, E.L. Layug, E.A. Lazo, K.A. Haratonik.
Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery.
Anesthesiology, 101 (2004), pp. 284-293
[30.]
M. Aho, A.M. Lehtinen, O. Erkola, A. Kallio, K. Korttila.
The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy.
Anesthesiology, 74 (1991), pp. 997-1002
[31.]
M.L. Jaakola, T. Ali-Melkkila, J. Kanto, A. Kallio, H. Scheinin, M. Scheinin.
Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery.
Br J Anaesth, 68 (1992), pp. 570-575
[32.]
B. Scheinin, L. Lindgren, T. Randell, H. Scheinin.
Scheinin M.
Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth, 68 (1992), pp. 126-131
[33.]
R. Aantaa, J. Kanto, M. Scheinin, A. Kallio, H. Scheinin.
Dexmedetomidine, an alpha 2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery.
Anesthesiology, 73 (1990), pp. 230-235
[34.]
A.E. Triltsch, M. Welte, P. von Homeyer, J. Grosse, A. Genahr, M. Moshirzadeh.
Bispectral indexguided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study.
Crit Care Med, 30 (2002), pp. 1007-1014
[35.]
A. Koroglu, S. Demirbilek, H. Teksan, O. Sagir, A.K. But, M.O. Ersoy.
Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results.
Br J Anaesth, 94 (2005), pp. 821-824
[36.]
Ah. Koroglu, H. Teksan, O. Sagir, A. Yucel, H. Toprak, O. Ersoy.
A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging.
Anesth Analg, 103 (2006), pp. 63-67
[37.]
D.N. Wijeysundera, J.S. Naik, W.S. Beattie.
Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis.
Am J Med, 114 (2003), pp. 742-752
[38.]
J. Jalonen, M. Hynynen, A. Kuitunen, H. Heikkila, J. Perttila, M. Salmenpera.
Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting.
Anesthesiology, 86 (1997), pp. 331-345
[39.]
A.K. But, U. Ozgul, F. Erdil, N. Gulhas, H.I. Toprak, M. Durmus.
The effects of preoperative dexmedetomidine infusion on hemodynamics in patients with pulmonary hypertension undergoing mitral valve replacement surgery.
Acta Anaesthesiol Scand, 50 (2006), pp. 1207-1212
[40.]
S. Sadhasivam, A. Boat, M. Mahmoud.
Comparison of patient-controlled analgesia with and without dexmedetomidine following spine surgery in children.
Journal of Clinical Anesthesia, 21 (2009), pp. 493-501
[41.]
G.B. Hammer, W.J. Sam, M.I. Chen, B. Golianu, D.R. Drover.
Determination of the pharmacodynamic interaction of propofol and dexmedetomidine during esophagogastroduodenoscopy in children.
Pediatric Anesthesia, 19 (2009), pp. 138-144
[42.]
B.M. Biccard, S. Goga, J. de Beurs.
Dexmedetomidine and cardiac protection for non-cardiac surgery: a meta-analysis of randomised controlled trials.
Anaesthesia, 63 (2008), pp. 4-14
[43.]
S. Ruesch, J. Levy.
Treatment of persistent tachycardia with dexmedetomidina during off-pump cardiac surgery.
Anesth Analg, 95 (2002), pp. 316-318
[44.]
M. Ickeringill, Y. Shehabi, H. Adamson, U. Ruettimann.
Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy.
Anaesth Intensive Care, 32 (2004), pp. 741-745
[45.]
Y. Abulhasan, N. Buu, C. Frigon.
Perioperative use of dexmedetomidine in an infant with familial dysautonomia.
British Journal of Anaesthesia, 103 (2009), pp. 413-415
[46.]
H. Bakhamees.
Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass.
Middle East Journal of Anesthesiology, 19 (2007),
[47.]
M. Shukry, K. Kennedy.
Dexmedetomidine as a total intravenous anesthetic in infants.
Pediatric anesthesia, 17 (2007), pp. 581-583
[48.]
N.M. Bulow, N.V. Barbosa, J.B. Rocha.
Opioid consumption in total intravenous anesthesia is reduced with dexmedetomidine: a comparative study with remifentanil in gynecologic videolaparoscopic surgery.
Journal of Clinical Anesthesia, 19 (2007), pp. 280-285
[49.]
V. Mani, N.S. Morton.
Overview of total intravenous anesthesia in children.
Pediatric Anesthesia, 20 (2010), pp. 211-222
[50.]
S.R. Arain, T.J. Ebert.
The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation.
Anesth Analg, 95 (2002), pp. 461-466
[51.]
N. Turgut, A. Turkmen, S. Gokkaya, A. Altan, M.A. Hatiboglu.
Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy.
Minerva Anestesiologica, 74 (2008), pp. 469-474
[52.]
D.S. Carollo, B.D. Nossaman, U. Ramadhyani.
Dexmedetomidine: a review of clinical applications; current opinion.
En: Anesthesiology, 21 (2008), pp. 456-461
[53.]
M. Aho, O. Erkola, A. Kallio, H. Scheinin, K. Korttila.
Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole.
J Clin Anesth, 5 (1993), pp. 194-203
Copyright © 2011. Revista Colombiana de Anestesiología
Opciones de artículo
Herramientas