Abstract
Optimal sedation strategy in the critically ill should
achieve effective analgesia, targeted sedation and reduced
risk of delirium and agitation. Whilst there is no single
agent that can achieve these goals for all patients, a
multimodal approach may optimise the use of different
agents through multiple modes of action and reduce
possible adverse events. This practice review provides
an evidence based and expert opinion on the practical
aspects of dexmedetomidine use as part of multimodal
ICU sedation.
Dexmedetomidine, when compared to conventional sedatives
and opiates, has been demonstrated to be associated
with both sedative and analgesic sparing effects, reduced
delirium and agitation, minimal respiratory depression and
predictable and desirable cardiovascular effects.
In the intensive care setting, dexmedetomidine has been
effectively used in post operative analgesia and sedation
of high risk and complex surgical patients, and during
transition from other conventional sedatives. Critically
ill patients requiring ventilation for more than 24 hours
and patients who experienced emergent agitation and
or delirium have also been successfully managed with a
dexmedetomidine regimen.
Yahya Shehabi, John A. Botha, David Ernest, Ross C. Freebairn, Michael Reade, Brigit L. Roberts, Ian Seppelt, Leonie Weisbrodt
