Dexmedetomidine for sedation and perioperative management of critically ill patients

Benzodiazepines and opioids are routinely used in the perioperative period and the intensive care unit (ICU) to prevent anxiety and pain. These agents have the potential for side effects that may worsen outcomes in critically ill patients. Alpha₂ agonists are increasingly being used as adjuvant therapeutic agents in the perioperative period because of their ability to block the sympathetic stress response, complete with their anesthetic and analgesic sparing properties, lack of respiratory depression, and low and predictable side effect profile. The recent approval of dexmedetomidine, a parentally administered alpha₂ agonist, provides an alternative to the conventional strategy of sedation and analgesia utilizing benzodiazepines and opiates. This state of the art review examines the physiological properties and uses of alpha₂ agonists, with emphasis on dexmedetomidine, in the perioperative period and in the ICU.