Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000100013
Brazilian Journal of Anesthesiology
Review Article

Uso de dexmedetomidina em anestesiologia

Dexmedetomidine in anesthesiology

Nivaldo Ribeiro Villela; Paulo do Nascimento Júnior

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Resumo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina é um novo agonista alfa2-adrenérgico que apresenta relação de seletividade entre os receptores alfa2:alfa1 de 1600:1, com importante ação sedativa e analgésica, bom controle hemodinâmico frente ao estresse e que pode produzir, por si só, anestesia. Este agente tem sido empregado para promover analgesia e sedação no período pós-operatório e nas unidades de tratamento intensivo. Devido à suas propriedades, recentemente, a dexmedetomidina passou a ser utilizada também na sala de operações, como fármaco coadjuvante em anestesia. Assim, este artigo faz uma revisão da literatura com relação ao uso da dexmedetomidina na prática anestésica. CONTEÚDO: São apresentados os principais trabalhos com o emprego da dexmedetomidina em Anestesiologia, seja como medicação pré-anestésica, ou durante o ato anestésico-cirúrgico. O mecanismo de ação dos fármacos alfa2-agonistas e as propriedades farmacocinéticas e farmacodinâmicas da dexmedetomidina também são revistos neste artigo. CONCLUSÕES: O uso da dexmedetomidina como medicação pré-anestésica, durante anestesia, ou no período pós-operatório, promove boa estabilidade hemodinâmica. Há redução do consumo de anestésicos durante a anestesia. Os pacientes sedados com a dexmedetomidina podem ser despertados, quando solicitados, e tornarem-se cooperativos. Mesmo doses elevadas do fármaco não provocam depressão respiratória. Bradicardia é um efeito adverso observado com freqüência, problema amenizado pela administração lenta da droga. Assim, a dexmedetomidina torna-se importante recurso adicional para a prática clínica da Anestesiologia, com possibilidade de uso em diversos tipos de pacientes e procedimentos cirúrgicos.

Palavras-chave

ANALGÉSICOS

Abstract

BACKGROUND AND OBJECTIVES: Dexmedetomidine is a new alpha2-adrenergic agonist with a selectivity ratio of 1600:1 (alpha2:alpha1). It has important sedative and analgesic effects, good hemodynamic control at stress situations and may, by itself, induce anesthesia. This drug has been used to promote postoperative and intensive care sedation and analgesia. Due to such properties, dexmedetomidine has recently become a co adjuvant drug for anesthesia. So, this is a review of the literature about dexmedetomidine in anesthesia. CONTENTS: Major studies on dexmedetomidine in Anesthesiology are presented, both as premedication and during anesthesia. Action mechanisms of alpha2-adrenergic agonists and dexmedetomidine pharmacokinetic and pharmacodynamic properties are also reviewed in this paper. CONCLUSIONS: Dexmedetomidine premedication, infusion during anesthesia or in the postoperative period improves hemodynamic stability. Anesthetic consumption is decreased during anesthesia. Patients sedated with dexmedetomidine may awake, when requested and become cooperative. Even high dexmedetomidine doses do not cause respiratory depression. Bradycardia is a frequent side effect which may be minimized by slow drug infusion. So, dexmedetomidine is an important additional resource to anesthetic practice that may be used in different patients and surgical procedures.

Keywords

ANALGESICS

References

Vickery RG, Sheridan BC, Segal IS. Anesthetic and hemodynamic effects of stereoisomers of medetomidine, an alpha2-adrenergic agonist, in halothane-anesthetized dogs. Anesth Analg. 1988;67:611-615.

Venn RM, Bradshaw CJ, Spencer R. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136-1142.

Stahle H. A historical perspective: development of clonidine. Baillière’s Clinical. Anesthesiology. 2000;14:237-246.

Jones MEP, Maze M. Can we characterize the central nervous system action of alpha2-adrenergic agonists?. Br J Anaesth. 2001;86:1-3.

Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology. 2000;93:1345-1349.

Oliver M, Goldman L, Julian D. Effect of mivazerol on perioperative cardiac complications during non-cardiac surgery in patients with coronary heart disease: he European Mivazerol Trial (EMIT). Anesthesiology. 1999;91:951-961.

Perioperative sympatholysis: beneficial effects of the alpha-2 adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. Anesthesiology. 1997;86:346-363.

Hayashi Y, Maze M. Alpha-2 adrenoceptor agonists and anesthesia. Br J Anaesth. 1993;71:108-118.

Tonner PH, Scholz J, Koch C. The anesthetic effect of dexmedetomidine does not adhere to the Meyer-Overton Rule but is reversed by hydrostatic pressure. Anesth Analg. 1997;84:618-622.

Tonner PH, Scholz J. Clinical perspectives of alpha-2 adrenoceptor agonists. Curr Opin Anaesthesiol. 1996;9:471-480.

Scholz J, Toner PH. Alpha-2 adrenoceptor agonists in anaesthesia: a new paradigm. Curr Opin Anaesthesiol. 2000;13:437-442.

Karhuvaara S, Kallio A, Salonen M. Rapid reversal of alpha2-adrenoceptor agonist effects by atipamazole in human volunteers. Br J Pharmac. 1991;31:160-165.

Stanko CK, Vandel MI, Bose R. Characterization of alpha2-adrenoceptors in the rat: proximal tubule, renal membrane and whole kidney studies. Eur J Pharmacol. 1990;175:13-20.

Docherty JR. Subtypes of functional alpha1- and alpha2-adrenoceptors. Eur J Pharmacol. 1998;361:1-15.

Saunders C, Limbird LE. Localization and trafficking of alpha2-adrenergic receptor subtypes in cells and tissues. Pharmacol Ther. 1999;84:193-205.

Gilman AG. G proteins: transducers of receptor-generated signals. Ann Rev Biochem. 1987;56:615-649.

Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists: Their pharmacology and therapeutic role. Anaesthesia. 1999;54:146-165.

Khan ZP, Munday IT, Jones RM. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers. 1: Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth. 1999;83:372-380.

Mantz J. Dexmedetomidine. Drugs Today. 1999;35:151-157.

Cunningham FE, Baughaman VL, Tonkovich L. Pharmacokinetics of dexmedetomidine in patients with hepatic failure. Clin Pharmacol Ther. 1999;65:128.

Dutta S, Lal R, Karol MD. Influence of cardiac output on dexmedetomidine pharmacokinetics. J Pharm Sci. 2000;89:519-527.

Wolf AMD, Fragen RJ, Avram MJ. The pharmacokinetics of dexmedetomidine in volunteers with severe renal impairment. Anesth Analg. 2001;93:1205-1209.

Ala-Kokko TI, Pienimaki P, Lampela E. Transfer of clonidine and dexmedetomidine across the isolated perfused human placenta. Acta Anaesthesiol Scand. 1997;41:313-319.

Kallio A, Scheinin M, Koulu M. Effects of dexmedetomidine, a selective alpha2-adrenoceptor agonist, on hemodynamic control mechanisms. Clin Pharmacol Ther. 1989;46:33-42.

Dyck JB, Maze M, Haack C. The pharmacokinetics and hemodynamic effects of intravenous and intramuscular dexmedetomidine hydrochloride in adult human volunteers. Anesthesiology. 1993;78:813-820.

Ebert TJ, Hall JE, Barney JA. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382-394.

Talke P, Tayefeh F, Sessler DI. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering thresholds. Anesthesiology. 1997;87:835-841.

Dutta S, Karol MD, Cohen T. Effect of dexmedetomidine on propofol requirements in healthy subjects. J Pharm Sci. 2001;90:172-181.

Talke PO, Caldwell JE, Richardson CA. The effects of dexmedetomidine on neuromuscular blockade in human volunteers. Anesth Analg. 1999;88:633-639.

Fukushima K, Nishimi Y, Mori K. The effect of epidural administered dexmedetomidine on central and peripheral nervous system in man. Anesth Analg. 1997;84:292S.

Aantaa RE, Kanto JH, Scheinin M. Dexmedetomidine premedication for minor gynecologic surgery. Anesth Analg. 1990;70:407-413.

Aho M, Scheinin M, Lehtinen AM. Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg. 1992;75:932-939.

Levanen J, Makela ML, Scheinin H. Dexmedetomidine premedication attenuates ketamine-induced cardiostimulatory effects and post anesthetic delirium. Anesthesiology. 1995;82:1117-1125.

Aantaa R, Jaakola M-L, Kallio A. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology. 1997;86:1055-1060.

Lawrence CJ, De Lange S. Effects of single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability. Anaesthesia. 1997;52:736-744.

Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years. J Clin Anesth. 1999;11:466-470.

Taittonen MT, Kirvela OA, Aantaa R. Effect of clonidine and dexmedetomidine premedication on perioperative oxygen consumption and haemodynamic state. Br J Anaesth. 1997;78:400-406.

Mann JJ, Manevitz AZ, Chen JS. Acute effects of single and repeated eletroconvulsive therapy on plasma catecholamines and blood pressure in major depressive disorder. Psychiatry Res. 1990;34:127-137.

Fu W, White PF. Dexmedetomidine failed to block the acute hyperdynamic response to eletroconvulsive therapy. Anesthesiology. 1999;90:422-424.

Peden CJ, Cloote AH, Stratford N. The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia. 2001;56:408-413.

Aho M, Erkola O, Kallio A. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominal hysterectomy. Anesth Analg. 1992;75:940-946.

Talke P, Jain U, Leung J. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. Anesthesiology. 1995;82:620-633.

Jalonen J, Hynynen M, Kuitunen A. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997;86:331-345.

Badner N, Trepanier C, Chen R. Perioperative use of dexmedetomidine improves patient analgesia and provides sedation without increasing side effects. Anesth Analg. 1999;88:314S.

Talke P, Chen R, Thomas B. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90:834-839.

Bekker A, Kaufman B, Samir H. The use of dexmedetomidine infusion for awake craniotomy. Anesth Analg. 2001;92:1251-1253.

Tranquilli WJ, Maze M. Clinical pharmacology and use of alpha2-adrenergic agonists in veterinary anaesthesia. Anaesth Pharmac Rev. 1993;1:297-309.

Virtanen R. Pharmacological profiles of medetomidine and its antagonist atipamezole. Acta Vet Scand. 1989;85:29-38.

Karhuvaara S, Kallio A, Salonen M. Rapid reversal of alpha2-adrenoceptor agonist effects by atipamezole in human volunteers. Br J Clin Pharmac. 1991;31:160-165.

Scheinin H, Aantaa R, Anttila M. Reversal of the sedative and sympatholytic effects of dexmedetomidine with a specific alpha2-adrenoceptor antagonist atipamezole: a pharmacodynamic and kinetic study in healthy volunteers. Anesthesiology. 1998;89:574-584.

Aho M, Erkola O, Kallio A. Comparison of dexmedetomidine and midazolam and antagonism of dexmedetomidine with atipamezole. J Clin Anesth. 1993;5:194-203.

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