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PAUL M. SZUMITA, PHARM.D., BCPS, is Clinical Pharmacy Practice Manager, Department of Pharmacy, Brigham and Women’s Hospital (BWH), Boston, MA. STEVEN A. BAROLETTI, PHARM.D., BCPS, is Clinical Pharmacy Practice Manager, BWH, and Adjunct Associate Professor, Northeastern University, Boston. KEVIN E. ANGER, PHARM.D., BCPS, is Senior Pharmacist, Department of Pharmacy, BWH. MICHAEL E. WECHSLER, M.M.SC., M.D., is Associate Physician, Pulmonary and Critical Care, BWH, and Instructor in Medicine, Harvard Medical School, Boston, MA.

Address correspondence to Dr. Szumita at the Department of Pharmacy, Tower L2, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115-6110 (pszumita{at}partners.org).

Purpose. A review highlighting the application of sedatives and analgesics in the intensive care unit (ICU) setting, with a focus on the use of dexmedetomidine, is presented. Summary. Relevant and applicable clinical trials that resulted from a search of the literature from 1966 to July 2006 using key search terms such as dexmedetomidine, intensive care unit, sedation, delirium, and analgesia were evaluated. Many agents have been evaluated in the search of the optimal regimen for sedation and analgesia in the ICU, including opioids, benzodiazepines, propofol, and antipsychotic agents. Dexmedetomidine has demonstrated efficacy as a sedative analgesic on the basis of its ability to lower opioid, benzodiazepine, and propofol requirements in clinical trials. The role of dexmedetomidine in ICU clinical practice is limited because of a lack of mortality and other morbidity endpoints, such as ICU length of stay, hospital length of stay, time to extubation, long-term complications after discharge from the ICU, and delirium. The most commonly reported adverse effects of dexmedetomidine are secondary to its effects as an 2-receptor agonist and are cardiac in nature. A detailed cost analysis may be warranted to justify the relatively high acquisition cost of dexmedetomidine. Conclusion. Dexmedetomidine may be an effective agent for ICU sedation and analgesia. However, the lack of clinically relevant endpoints in trials, the concern about adverse cardiovascular effects, and the relatively high acquisition cost of this drug limit its use to a select number of patients who may benefit from its distinguished mechanism of action. Index terms: Anxiolytics, sedatives and hypnotics; Costs; Dexmedetomidine; Drug use; Hospitals; Mechanism of action; Pharmacoeconomics; Toxicity

 

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