France: Dexmedetomidine - More Than Just an Anesthetic Aid?

A recent editorial published in Anaesthesia Critical Care & Pain Medicine explores the multifaceted role of dexmedetomidine, posing the question: Is it more than just an anesthetic aid? The article provides an overview of the latest evidence regarding this highly selective alpha-2 adrenergic agonist, highlighting its potential benefits beyond traditional anesthetic applications.

Dexmedetomidine is a highly selective alpha-2 agonist recognized for its analgesic, sedative, and anti-anxiolytic properties, all with minimal respiratory depression. Recently, its organ-protective and anti-inflammatory effects have gained attention. Traditionally, dexmedetomidine has played an adjunctive role in anesthesia, helping to reduce the need for hypnotic agents, facilitating opioid-free anesthesia, and improving postoperative outcomes related to nausea, vomiting, delirium, and pain.

Emerging research highlights additional potential benefits, such as reducing postoperative sleep disturbances and acute kidney injury (AKI), both of which are associated with inflammation. These issues are prevalent in surgical settings and can lead to increased mortality, prolonged hospital stays, and heightened patient distress.

This raises the question: does the perioperative use of dexmedetomidine offer more than just anesthetic support? Beyond its traditional role, it may positively influence the physiological and emotional outcomes of surgery.

In their article, Raphael Cinotti, MethodS in Patients-centered Outcomes and HEalth Research, SPHERE, Nantes, France, and colleagues present a comprehensive overview of dexmedetomidine regarding sleep disturbances and acute kidney injury while also offering a broader perspective on its effects during perioperative administration.

Recent Studies

Two recent studies have shed light on the role of dexmedetomidine in addressing postoperative acute kidney injury (AKI) and sleep disturbances.

• In a meta-analysis by Zhuang et al., which reviewed 23 randomized control trials, compelling evidence emerged linking intraoperative administration of dexmedetomidine—either as a bolus (0.4 to 1.5 mg/kg) or continuous infusion (0.1 to 1 mg/kg/h)—to a reduction in postoperative AKI, assessed by established criteria. This study highlighted secondary benefits, including improved urine output, inflammation markers, and overall renal function, alongside reduced nausea and vomiting. Although some secondary outcomes received low-GRADE scores, the primary findings on AKI received high GRADE ratings, reinforcing the drug's potential renal protective effects.

• Meanwhile, Dong et al. conducted a double-blind randomized control trial focusing on postoperative sleep disturbances in women undergoing breast surgery. Utilizing a clinical insomnia scale and Fitbit data for sleep analysis, the study found no significant difference in sleep disturbance between those receiving dexmedetomidine (1.0 mg/kg before induction) and a placebo. However, improvements in sleep structure—specifically nocturnal wakefulness and deep sleep—were noted with dexmedetomidine across different anesthesia regimens.

While these studies suggest dexmedetomidine's potential in mitigating AKI and enhancing sleep quality, they also raise questions about dosing protocols and the consistency of results. There were increased incidences of hypotension and bradycardia, although some literature suggests dexmedetomidine might present a safer profile compared to traditional opioids like remifentanil.

Conclusion

To conclude, the findings of Zhuang et al. and Dong et al. provide valuable insights into dexmedetomidine's effects on AKI and sleep disturbances. However, further research is needed to clarify optimal dosing and timing and to explore its impact across diverse patient populations.

Reference

Cinotti R, Studd H, Forget P. Dexmedetomidine, more than just an anaesthetic aid? An overview of latest evidence. Anaesth Crit Care Pain Med. 2024 Jul 9;43(5):101406. doi: 10.1016/j.accpm.2024.101406. Epub ahead of print. PMID: 38992467.