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Chapter 8
Perioperative use
Dexmedetomidine has the potential to gain a place in the perioperative setting. Its sedative,
analgesic, and anxiolytic effects make it a suitable agent for premedication.
An anticipated difficult airway necessitates an awake fiberoptic intubation. To minimise
stressful moments for the patient, sedation offers a most welcome support. However, it is
important to keep the patient cooperative and spontaneously breathing. Dexmedetomidine
can meet this requirement in contrast to other sedatives and additionally provide a
reduction of salivation.
During awake craniotomies an active participation of the patient in surgery is necessary and
expected. Tanskanen et al.
10
showed that awakening, extubation, and obtaining of adequate
spontaneous breathing is reached more quickly with dexmedetomidine in comparison
with fentanyl. Patients indeed were sedated but respond adequately.
During the postoperative phase, dexmedetomidine can reduce the necessary amount of
opioids. Especially with patients at risk for a compromised airway, dexmedetomidine may
play an important role.
Procedural Sedation
The demand for sedation support during minimal invasive procedures is continuously
growing. Most hospitals have specific protocols for sedation during colonoscopies,
gastroscopies, and ERCP’s. Medication varies from midazolam to propofol, often combined
with an opiate; sedation is often administered by specially trained anaesthesia nurses for
procedural sedation (PSA). The on-going question is whether dexmedetomidine also could
play a role in procedural sedation.
Till now, a number of small studies had been performed studying endoscopist`s and
patients satisfaction. For sedation during procedures that are unpleasant but not painful,
dexmedetomidine certainly has a value. Patients are more cooperative, less retching, and
afterwards just as satisfied as patients who received midazolam. Also, the endoscopist is
more satisfied with patients of the dexmedetomidine group.
11
Painful procedures such as
colonoscopies often necessitate opiates as rescue medication and longer recovery times
due to hypotension and bradycardia. In addition, for the acute colic pain during ERCP’s,
dexmedetomidine has not sufficient analgesic effect. The same is shown in healthy
volunteers: dexmedetomidine has no effect on experimental acute pain.
12
Future
For paediatric sedation, dexmedetomidine is still used off-label. Nevertheless, it seems
to be a welcome addition to standard used sedatives. During MRI, children sedated with
dexmedetomidine remained calmer compared to midazolam, and recovered faster in