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Greenwood J, Crull A, Graves M, Ledvina M. Pharmacological interventions for reducing the incidence of myoclonus in patients receiving etomidate for induction of general anesthesia: an umbrella review. JBI Evid Synth 2024; 22:66-89. [PMID: 37560913 DOI: 10.11124/jbies-22-00390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The objective of this umbrella review was to examine various pharmacologic interventions for their potential to reduce etomidate-induced myoclonus. A secondary objective was to compare the relative effectiveness of those medications in reducing the incidence of myoclonus when etomidate is utilized for the induction of general anesthesia. INTRODUCTION Etomidate is the drug of choice when inducing general anesthesia in hemodynamically unstable patients. However, its use is limited among the general surgical population due to its ability to cause adrenal suppression, vomiting, and myoclonus. Myoclonus can lead to damage of muscle fibers, myalgias, and patient discomfort, and can also be detrimental in patients with low cardiac reserve. Several systematic reviews have reported on the effectiveness of various intravenous medications in reducing mild, moderate, and severe myoclonus; however, a more thorough examination of their influence was lacking. INCLUSION CRITERIA This review included systematic reviews and meta-analyses of randomized controlled trials involving the use of pharmacologic interventions to reduce etomidate-induced myoclonus. Reviews in English and conducted after 1965 were considered for inclusion. METHODS A comprehensive search of 11 databases was conducted to identify published and unpublished reviews up to March 2022. Critical appraisal was conducted by 2 independent reviewers using the standardized JBI appraisal tool. Quantitative findings were summarized according to the dose, timing of administration, and relative risk using a data matrix, and were synthesized in tabular format with supporting narrative text. Results were organized by severity of myoclonus (overall, mild, moderate, and severe) and by type of intervention. RESULTS Eight systematic reviews were included in this umbrella review, which included 48 relevant studies, after removal of duplicates (3909 participants included in the primary studies). Five of the systematic reviews examined the effectiveness of various types of opioids in the prevention of myoclonus, and 3 systematic reviews examined the effectiveness of non-opioid interventions, such as lidocaine, midazolam, and dexmedetomidine. Seven reviews searched at least 4 databases for pertinent studies and specifically indicated that blinded reviewers appraised the articles. All reviews used a published and validated appraisal instrument. The overall quality of all included reviews was judged to be moderate to high. The absolute risk reduction indicating the effectiveness of the prophylactic medications ranged from 47% to 81% for mild, 52% to 92% for moderate, and 61% to 96% for severe myoclonus. Opioids demonstrated the most consistent and substantial effect on the reduction in myoclonus. CONCLUSIONS All pharmacologic interventions identified in this review demonstrated a statistically significant reduction in the incidence of myoclonus. Future studies and reviews should focus on elucidating the particular dose range and timing that is most effective. Anesthesia providers should consider a pre-treatment dose of one of the medications described in this umbrella review as a means to reduce myoclonus and the untoward effects of that condition.
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Affiliation(s)
- Jennifer Greenwood
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- RFU Center for Interprofessional Evidence Based Practice: A JBI Centre of Excellence, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Allison Crull
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Melissa Graves
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Michael Ledvina
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
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Rabie A, Abdelfattah MR. Outcome of intraoperative dexmedetomidine infusion in laparoscopic cholecystectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2004501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Aliaa Rabie
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - MR Abdelfattah
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ye Q, Wang F, Xu H, Wu L, Gao X. Effects of dexmedetomidine on intraoperative hemodynamics, recovery profile and postoperative pain in patients undergoing laparoscopic cholecystectomy: a randomized controlled trial. BMC Anesthesiol 2021; 21:63. [PMID: 33648441 PMCID: PMC7919082 DOI: 10.1186/s12871-021-01283-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the optimal dose of dexmedetomidine to maintain hemodynamic stability, prevent of cough and minimize postoperative pain for patients undergoing laparoscopic cholecystectomy. METHODS One hundred twenty patients were randomly divided into D1, D2, D3 and NS groups, and dexmedetomidine 0.4, 0.6, 0.8μg/kg and normal saline were administrated respectively. Patients' heart rate, systolic blood pressure and diastolic blood pressure were measured at T1-T7. The incidence of cough was recorded. Other parameters were noted, the time of spontaneous respiratory recovery and extubation, visual analogue scale scores and dosage of tramadol. RESULTS The heart rate, systolic blood pressure and diastolic blood pressure of D2 and D3 groups has smaller fluctuations at T2-3 and T7 compared with NS and D1 groups (P < 0.05). The incidence of cough was lower in D2 and D3 groups than NS group (P < 0.05). The visual analogue scale scores and tramadol dosage of D2 and D3 groups were lower than NS group (P < 0.05). The time of spontaneous respiratory recovery and extubation in D3 group was longer than that in D1 and D2 groups (P < 0.05). CONCLUSIONS Intravenous infusion of 0.6μg/kg dexmedetomidine before induction can maintain hemodynamic stability, decrease cough during emergence, relieve postoperative pain of patients undergoing laparoscopic cholecystectomy. TRIAL REGISTRATION ChiCTR1900024801 , registered at the Chinese Clinical Trial Registry, principal investigator: Qin Ye, date of registration: July 28, 2019.
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Affiliation(s)
- Qin Ye
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Fangjun Wang
- Affiliated Hospital of North Sichuan Medical College, No. 63, Wenhua Road, Shunqing District, Nanchong City, Sichuan Province, China.
| | - Hongchun Xu
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Le Wu
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
| | - Xiaopei Gao
- North Sichuan Medical College, No. 234, Fujiang Road, Shunqing District, Nanchong City, Sichuan Province, China
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Saleh AAG, Sultan A, Hammouda MA, Shawki A, El Ghaffar MA. Value of Adding Dexmedetomidine in Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis for Treatment of Pancreatic Cancer-Associated Pain. J Gastrointest Cancer 2020; 52:682-689. [PMID: 32621112 DOI: 10.1007/s12029-020-00449-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Abdominal and back pain is present in up to 80% of patients with pancreatic cancer and represents a significant cause of morbidity. Celiac plexus neurolysis (CPN) demonstrated good results in relief of pain of upper abdominal malignancy. Dexmedetomidine is alpha-2 adrenoceptor highly selective agonist approved for procedural sedation use. PATIENTS AND METHODS Fifty patients divided in two groups with locally advanced pancreatic cancer-associated abdominal pain underwent endoscopic ultrasound (EUS)-guided CPN using bupivacaine 0.5% alone with alcohol for the first group and bupivacaine 0.5% plus dexmedetomidine in the second. Patients scored their pain according to the Numeric Rating Scale (NRS-11) before, 2, 4, 6, 8, 12, 16, and 24 week after the procedure. RESULTS The study has included 50 patient in two groups. There was no significant difference between the two groups as regards medical, laboratory, or tumor characters. The median pain score decreases from 8.32 ± 0.75 before the procedure to 3.75 ± 3.72 24 week after the procedure in group 1 and from 8.08 ± 0.86 before to 1.67 ± 2.3 24 week after the procedure in group 2. However, there was no significant difference between the two groups in the median pain score during the first 4 weeks. There was no statistically significant difference between the two groups as regards the median survival time. CONCLUSION The addition of dexmedetomidine to bupivacaine 0.5% in EUS-CPN demonstrated beneficial effects as regards the degree and duration of pain relieve with negligible effect on the patient survival.
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Affiliation(s)
- Ahmed Abdel Ghafar Saleh
- Department of Internal Medicine, Hepatology & Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt. .,Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Ahmed Sultan
- Department of Internal Medicine, Hepatology & Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed A Hammouda
- Department of Internal Medicine, Hepatology & Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Shawki
- Department of Internal Medicine, Hepatology & Gastroentrology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Abd El Ghaffar
- Department of Surgical Oncology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Kamal M, Agarwal D, Singariya G, Kumari K, Paliwal B, Ujwal S. Effect of dexmedetomidine on attenuation of hemodynamic response to intubation, skin incision, and sternotomy in coronary artery bypass graft patients: A double-blind randomized control trial. J Anaesthesiol Clin Pharmacol 2020; 36:255-260. [PMID: 33013044 PMCID: PMC7480302 DOI: 10.4103/joacp.joacp_353_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 07/24/2019] [Accepted: 10/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background and Aims: Coronary artery bypass grafting (CABG) surgery involves various noxious stimuli resulting in stress response, which in turn increases the risk of perioperative myocardial ischemia. The present study was conducted to evaluate the effect of dexmedetomidine on the attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery. Material and Methods: Sixty patients were randomized into two groups of 30 each. Group D patients received dexmedetomidine 1 μg/kg as loading dose over 10 min, followed by continuous infusion of 0.5 μg/kg/h. In group P, normal saline was infused as loading and maintenance dose at similar rate. Hemodynamic parameters, total induction dose of thiopentone, and adverse effects were recorded. Statistical analysis was performed using SPSS version 20.0. Chi-square test and ANNOVA test were used and P < 0.05 was considered significant. Results: The percentage increase in heart rate was significantly lesser in group D than group P after intubation (7.04% v/s 15.08%), skin incision (5.91% v/s 10.11%), and sternotomy (5.33% v/s 11.65%). Similarly increase in systolic, diastolic, and mean blood pressure were significantly lesser in group D than group P after intubation, skin incision, and sternotomy. There was a significant reduction of mean total of thiopentone in group D in comparison to group P. (1.16 mg/kg v/s 2.44 mg/kg) (P<0.001). Conclusion: Dexmedetomidine resulted in significant attenuation of hemodynamic response to intubation, skin incision, and sternotomy in CABG surgery without significant adverse effects. It also significantly reduced the dose of thiopentone required for induction.
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Affiliation(s)
- Manoj Kamal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Deepa Agarwal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Geeta Singariya
- Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India
| | - Kamlesh Kumari
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharat Paliwal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shobha Ujwal
- Department of Anaesthesiology and Critical Care, Dr S N Medical College, Jodhpur, Rajasthan, India
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Semenas E, Lönnemark M, Dahlman P, Hultström M, Eriksson M. Analgesic effects of dexmedetomidine and remifentanil on periprocedural pain during percutaneous ablation of renal carcinoma. Ups J Med Sci 2020; 125:52-57. [PMID: 32067572 PMCID: PMC7054959 DOI: 10.1080/03009734.2020.1720047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Percutaneous ablation of renal carcinoma is frequently a favourable treatment alternative, especially in elderly patients suffering from co-morbidities. Also, it is less resource-demanding than conventional surgery of renal carcinoma, and one may, therefore, assume that the incidence of this procedure may increase. Analgesia is necessary during this intervention. The aim of this study was to explore the possibility of analgosedation and its relation to patient comfort and safety during percutaneous ablation of renal carcinoma.Methods: Forty-six patients, sedated with dexmedetomidine and remifentanil, supplemented with infiltration anaesthesia (lidocaine 1%), underwent percutaneous (radiofrequency or microwave) ablation of renal carcinoma in this prospective study.Results: The patients expected pain intensity around the numerical rating score (NRS) 4.5 (interquartile range [IQR] 3.5-5.5), which was slightly lower than pain experienced during the procedure NRS 5 (IQR 2-7; p = 0.49). Eight percent of the patients needed supplementary morphine during the ablation procedure. Sedation score did not differ during ablation, at arrival to or discharge from the recovery ward. Median periprocedural treatment time was 12 minutes (IQR 12-16). Treatment time did not correlate with experienced pain (R2=0.000074, p = 0.96). The median length of stay in the recovery room was 120 minutes (IQR 84-154). There were seven serious adverse events.Conclusions: This proof-of-concept study has shown that analgosedation during percutaneous ablation of renal carcinoma can be performed with a generally tolerable degree of patient satisfaction. However, pain occurs and should be managed adequately. Patient safety must be a major concern for the anaesthetic care.
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Affiliation(s)
- Egidijus Semenas
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Lönnemark
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Dahlman
- Section of Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Hultström
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Section for Integrative Physiology, Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
| | - Mats Eriksson
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- CONTACT Mats Eriksson Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University Hospital, 751 85 Uppsala, Sweden
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Karakka Kal AK, Nalakath J, Kunhamu Karatt T, Perwad Z, Mathew B, Subhahar M. Development and validation of a chiral LC-MS method for the enantiomeric resolution of (+) and (-)-medetomidine in equine plasma by using polysaccharide-based chiral stationary phases. Chirality 2020; 32:314-323. [PMID: 31925851 DOI: 10.1002/chir.23166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/17/2019] [Accepted: 12/17/2019] [Indexed: 01/07/2023]
Abstract
The detection and separation of medetomidine enantiomers from the complex biological matrices poses a great analytical challenge, especially in the field of forensic toxicology and pharmacology. Couple of researchers reported resolution of medetomidine using protein-based chiral columns, but the reported method is quiet challenging and tedious to be employed for routine analysis. This research paper reported a method that enables the enantio-separation of medetomidine by using polysaccharide cellulose chiral column. The use of chiralcel OJ-3R column was found to have the highest potential for successful chiral resolution. Ammonium hydrogen carbonate was the ideal buffer salt for chiral liquid chromatography (LC) with electrospray ionization (ESI)+ mass spectrometry (MS) detection for the successful separation and detection of racemic compound. The method was linear over the range of 0 to 20 ng/mL in equine plasma and the inter-day precisions of levomedetomidine, dexmedetomidine were 1.36% and 1.89%, respectively. The accuracy of levomedetomidine was in the range of 99.25% to 101.57% and that for dexmedetomidine was 99.17% to 100.99%. The limits of quantification for both isomers were 0.2 ng/mL. Recovery and matrix effect on the analytes were also evaluated. Under the optimized conditions, the validated method can be adapted for the identification and resolution of the medetomidine enantiomers in different matrices used for drug testing and analysis.
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Affiliation(s)
| | - Jahfar Nalakath
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | | | - Zubair Perwad
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | - Binoy Mathew
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
| | - Michael Subhahar
- Equine Forensic Unit, Central Veterinary Research Laboratory, Dubai, United Arab Emirates
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Krait S, Scriba GKE. Quality by design-assisted development of a capillary electrophoresis method for the chiral purity determination of dexmedetomidine. Electrophoresis 2018; 39:2575-2580. [PMID: 29600596 DOI: 10.1002/elps.201800100] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 12/29/2022]
Abstract
Dexmedetomidine is a selective α2 -adrenergic agonist used for patient sedation, while its enantiomer levomedetomidine has no sedative effects. As CE has been shown to be a powerful technique for enantiomer analysis, the aim of the study was the quality by design-based development of a CE-based limit test for the enantiomeric impurity levomedetomidine. The analytical target profile was defined that the method should be able to determine levomedetomidine with acceptable precision and accuracy at the 0.1% level. From initial scouting experiments, sulfated β-cyclodextrin was selected as chiral selector. The critical process parameters were identified in a fractional factorial resolution V+ design, while a central composite face centered design and Monte Carlo simulations were used for defining the design space of the method. The selected working conditions were a 21.3/31.5 cm, 50 μm id fused-silica capillary, a 50 mM sodium phosphate buffer, pH 6.5, containing 40 mg/mL sulfated β-cyclodextrin, a capillary temperature of 17°C and an applied voltage of 10 kV. Validation according to the ICH guideline Q2(R1) demonstrated repeatability and intermediate precision of content and migration time between 9.3 and 4.2% with accuracy in the range of 92.0 and 98.9%.
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Affiliation(s)
- Sulaiman Krait
- Friedrich Schiller University, Department of Medicinal/Pharmaceutical Chemistry, Jena, Germany
| | - Gerhard K E Scriba
- Friedrich Schiller University, Department of Medicinal/Pharmaceutical Chemistry, Jena, Germany
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Quail A, Ravindran B, Cottee D, Johnstone J, White S. Dexmedetomidine Modification of the Chemoreflex Response to Severe Arterial Hypoxia in the Rabbit. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.601.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anthony Quail
- Cardiovascular ProgramHunter Medical Research InstituteNew Lambton HeightsAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
| | - Bhavi Ravindran
- Cardiovascular ProgramHunter Medical Research InstituteNew Lambton HeightsAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
| | - David Cottee
- Cardiovascular ProgramHunter Medical Research InstituteNew Lambton HeightsAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
| | - Janice Johnstone
- Cardiovascular ProgramHunter Medical Research InstituteNew Lambton HeightsAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
| | - Saxon White
- Cardiovascular ProgramHunter Medical Research InstituteNew Lambton HeightsAustralia
- School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
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Weatherall M, Aantaa R, Conti G, Garratt C, Pohjanjousi P, Lewis MA, Moore N, Perez-Gutthann S. A multinational, drug utilization study to investigate the use of dexmedetomidine (Dexdor®) in clinical practice in the EU. Br J Clin Pharmacol 2017; 83:2066-2076. [PMID: 28345249 PMCID: PMC5555873 DOI: 10.1111/bcp.13293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 03/08/2017] [Accepted: 03/17/2017] [Indexed: 01/27/2023] Open
Abstract
Aims Dexmedetomidine (dexdor®) is approved in the European Union (EU) for sedation of adults in the intensive care unit (ICU). The present observational, retrospective study was requested by the European Medicines Agency to investigate dexmedetomidine use in clinical practice, with a particular focus on off‐label use, including the paediatric population. Methods Study countries and sites were chosen from those with highest dexmedetomidine use, based on sales. Site selection (blind) was conducted by a multispecialist, independent group. Anonymized data on demographics, treatment indication, dexmedetomidine dosing, concomitant medications and treatment effectiveness were collected retrospectively from records of all dexmedetomidine‐treated patients at the site during the enrolment period. Informed consent was waived, to avoid influencing the prescribing of dexmedetomidine. Recruitment was completed within 18 months of first site initiation. Results Data from 2000 patients were collected from 16 hospitals in four EU countries (Finland 750, Poland 505, Germany 470, Austria 275). The median age was 62 years, with more males (70.2%) than females. Dexmedetomidine was primarily used in the adult ICU (86.0%) for ICU sedation (78.6%) and mostly dosed according the product label. The intended sedative effect was obtained in 84.9% of administrations. Paediatric use (5.9% of patients, mostly in Austria and Finland) occurred mainly in the adult or paediatric ICU (75.6%) for sedation (67.2%). Conclusions Overall, most patients were treated with dexmedetomidine according to the product labelling. Use in children was limited but significant and similar in scope to that in adults. Administrations not fully according to the product labelling usually occurred in an ICU environment and reflected extensively investigated clinical uses of dexmedetomidine.
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Affiliation(s)
- Mary Weatherall
- Study Manager, Orion Pharma, PO Box 6792, Nottingham,, NG1 1AH, UK
| | - Riku Aantaa
- Perioperative Services, Intensive care, Emergency Care and Pain Medicine, University of Turku, Turku, Finland
| | - Giorgio Conti
- Anaesthesia and Intensive Care Medicine, Catholic University of Rome, Rome, Italy
| | - Chris Garratt
- Development Leader, Orion Pharma, PO Box 6792, Nottingham, NG1 1AH, UK
| | - Pasi Pohjanjousi
- Biostatistician, Orion Pharma, Volttikatu 8, P.O.Box 1780, 70701, Kuopio, Finland
| | - Michael A Lewis
- EPES Epidemiology GmbH, Wulffstr. 8, D-12165, Berlin, Germany
| | - Nicholas Moore
- Bordeaux Pharmacoepi, University of Bordeaux, 146 rue Léo Saignat ▪, 33076, Bordeaux cedex, France
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Adams PS, Cassara A. Dexmedetomidine-related polyuria in a pediatric patient. J Anesth 2015; 30:352-5. [DOI: 10.1007/s00540-015-2101-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/01/2015] [Indexed: 10/22/2022]
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