• Mark S Siobal, Richard H Kallet, Valerie A Kivett, and Julin F Tang.
• Respiratory Care Services, Department of Anesthesia and Perioperative Care, San Francisco General Hospital, CA 94110, USA.
• Resp Care. 2006 May 1;51(5):492-6.

IntroductionDexmedetomidine is a selective alpha-2 adrenergic receptor agonist that exhibits sedative, analgesic, anxiolytic, and sympatholytic effects without respiratory-drive depression. We prospectively evaluated the use of dexmedetomidine to facilitate the withdrawal of mechanical ventilation and extubation in 5 trauma/surgical intensive-care-unit patients who had failed previous weaning attempts due to agitation and hyperdynamic cardiopulmonary response.MethodsIntravenous infusion of dexmedetomidine commenced at 0.5 or 0.7 microg/kg/h without a loading dose. Background sedation and analgesia with propofol, benzodiazepines, and opiates was discontinued or reduced as tolerated. Dexmedetomidine infusion was titrated between 0.2 and 0.7 microg/kg/h to maintain a stable cardiopulmonary response and modified Ramsay Sedation Score between 2 and 4.ResultsFollowing dexmedetomidine administration, propofol infusion was weaned and discontinued in 4 patients. In the fifth patient, benzodiazepine and opiate infusions were reduced. Ventilatory support in all patients could be weaned to continuous positive airway pressure of 5 cm H2O without agitation, hemodynamic instability, or respiratory decompensation. All patients were extubated while receiving dexmedetomidine infusion (mean dose of 0.32 +/- 0.08 microg/kg/h). One patient required reintubation for upper-airway obstruction.ConclusionDexmedetomidine appears to maintain adequate sedation without hemodynamic instability or respiratory-drive depression, and thus may facilitate extubation in agitated difficult-to-wean patients; it therefore deserves further investigation toward this novel use.

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