domingo, 19 de abril de 2015

Dexmedetomidine

Dexmedetomidina en la práctica anestésica actual. Un revisión
Dexmedetomidine in current anaesthesia practice- a review.
Naaz S, Ozair E.
J Clin Diagn Res. 2014 Oct;8(10):GE01-4. doi: 10.7860/JCDR/2014/9624.4946. Epub 2014 Oct 20.
Abstract
Dexmedetomidine is an alpha 2 adrenergic receptor agonist, even ten times more selective than clonidine. It is a very versatile drug in anaesthesia practice, finding place in increasing number of clinical scenarios and is no more limited to intensive care unit (ICU) sedation. It is analgesic, has anaesthetic sparing effect, sympatholytic property, useful in other procedural sedation and also has cardiovascular stabilizing property. It reduces delirium and preserves respiratory function which adds benefits to its uses. The aim of this review is to make awareness of its role in present anaesthesia and discuss its limitations at the same time.
KEYWORDS: Alpha 2 adrenergic agonist; Anaesthesia; Dexmedetomidine; Intensive care unit
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Variabilidad interpacientes de la respuesta a dexmedetomidina. Revisión de la literatura
Interpatient variability in dexmedetomidine response: a survey of the literature.
Holliday SF1, Kane-Gill SL2, Empey PE2, Buckley MS3, Smithburger PL2.
ScientificWorldJournal. 2014 Jan 16;2014:805013. doi: 10.1155/2014/805013. eCollection 2014
Abstract
Fifty-five thousand patients are cared for in the intensive care unit (ICU) daily with sedation utilized to reduce anxiety and agitation while optimizing comfort. The Society of Critical Care Medicine (SCCM) released updated guidelines for management of pain, agitation, and delirium in the ICU and recommended nonbenzodiazepines, such as dexmedetomidine and propofol, as first line sedation agents. Dexmedetomidine, an alpha-2 agonist, offers many benefits yet its use is mired by the inability to consistently achieve sedation goals. Three hypotheses including patient traits/characteristics, pharmacokinetics in critically ill patients, and clinically relevant genetic polymorphisms that could affect dexmedetomidineresponse are presented. Studies in patient traits have yielded conflicting results regarding the role of race yet suggest that dexmedetomidine may produce more consistent results in less critically ill patients and with home antidepressant use. Pharmacokinetics of critically ill patients are reported as similar to healthy individuals yet wide, unexplained interpatient variability in dexmedetomidine serum levels exist. Genetic polymorphisms in both metabolism and receptor response have been evaluated in few studies, and the results remain inconclusive. To fully understand the role ofdexmedetomidine, it is vital to further evaluate what prompts such marked interpatient variability in critically ill patients.
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Helen Gharaee
Anestesia y Medicina del Dolor
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