TY - JOUR
T1 - Dexmedetomidine pharmacodynamics
T2 - Part I - Crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers
AU - Hsu, Yung Wei
AU - Cortinez, Luis I.
AU - Robertson, Kerri M.
AU - Keifer, John C.
AU - Sum-Ping, Sam T.
AU - Moretti, Eugene W.
AU - Young, Christopher C.
AU - Wright, David R.
AU - MacLeod, David B.
AU - Somma, Jacques
PY - 2004/11
Y1 - 2004/11
N2 - Background: Dexmedetomidine, a highly selective α 2- adrenoceptor agonist used for short-term sedation of mechanically ventilated patients, has minimal effect on ventilation. Methods: This study compared the respiratory effect of dexmedetomidine to that of remifentanil. The authors measured and compared respiratory responses of six healthy male volunteers during (1) a stepwise target-controlled infusion of remifentanil, (2) a stepwise target-controlled infusion of dexmedetomidine, and (3) a pseudonatural sleep session. Results: Compared with baseline, remifentanil infusions resulted in respiratory depression as evidenced by a decrease in respiratory rate and minute ventilation, respiratory acidosis, and apnea episodes resulting in desaturations. Remifentanil disturbed the natural pattern of breathing and flattened the distribution of ventilatory timing (inspiratory time/ventilatory cycle time). The respiratory effects of dexmedetomidine markedly contrasted with those of remifentanil. When compared with baseline, during dexmedetomidine infusions, the respiratory rate significantly increased, and the overall apnea/hypopnea index significantly decreased. The distribution of inspiratory time/ventilatory cycle time showed an increased peak. In addition, dexmedetomidine seemed to mimic some aspect of natural sleep. While the subjects were breathing a 5% CO 2 mixture, hypercapnic arousal phenomena (documented by the Bispectral Index, the electroencephalogram, and sudden increase in the minute ventilation) were observed during dexmedetomidine infusions. Similar phenomena during natural sleep have been reported in the literature. Conclusions: In comparison with remifentanil, dexmedetomidine infusions (1) did not result in clinically significant respiratory depression, (2) decreased rather than increased the apnea/hypopnea index, and (3) exhibited some similarity with natural sleep.
AB - Background: Dexmedetomidine, a highly selective α 2- adrenoceptor agonist used for short-term sedation of mechanically ventilated patients, has minimal effect on ventilation. Methods: This study compared the respiratory effect of dexmedetomidine to that of remifentanil. The authors measured and compared respiratory responses of six healthy male volunteers during (1) a stepwise target-controlled infusion of remifentanil, (2) a stepwise target-controlled infusion of dexmedetomidine, and (3) a pseudonatural sleep session. Results: Compared with baseline, remifentanil infusions resulted in respiratory depression as evidenced by a decrease in respiratory rate and minute ventilation, respiratory acidosis, and apnea episodes resulting in desaturations. Remifentanil disturbed the natural pattern of breathing and flattened the distribution of ventilatory timing (inspiratory time/ventilatory cycle time). The respiratory effects of dexmedetomidine markedly contrasted with those of remifentanil. When compared with baseline, during dexmedetomidine infusions, the respiratory rate significantly increased, and the overall apnea/hypopnea index significantly decreased. The distribution of inspiratory time/ventilatory cycle time showed an increased peak. In addition, dexmedetomidine seemed to mimic some aspect of natural sleep. While the subjects were breathing a 5% CO 2 mixture, hypercapnic arousal phenomena (documented by the Bispectral Index, the electroencephalogram, and sudden increase in the minute ventilation) were observed during dexmedetomidine infusions. Similar phenomena during natural sleep have been reported in the literature. Conclusions: In comparison with remifentanil, dexmedetomidine infusions (1) did not result in clinically significant respiratory depression, (2) decreased rather than increased the apnea/hypopnea index, and (3) exhibited some similarity with natural sleep.
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U2 - 10.1097/00000542-200411000-00005
DO - 10.1097/00000542-200411000-00005
M3 - Article
C2 - 15505441
AN - SCOPUS:7244239373
SN - 0003-3022
VL - 101
SP - 1066
EP - 1076
JO - Anesthesiology
JF - Anesthesiology
IS - 5
ER -