Dexmedetomidine for Prevention of Postoperative Delirium

Abstract

Dexmedetomidine is a highly selective alpha 2 adrenergic receptor agonist that exerts its effects by inhibiting the sympathetic nervous system and increasing the activity of the parasympathetic nervous system, resulting in patient sedation and pain relief. It is a short-term sedative effect, allowing patients to remain calm while still being easily awakened and assessed after surgery. Importantly, this medication does not affect respiratory function. Dexmedetomidine was approved by the U.S. Food and Drug Administration at the end of 1999 for sedation of initially intubated and mechanically ventilated patients in the intensive care unit and sedation of non-intubated patients before or during other surgical procedures by continuous infusion not exceed 24 hours. Subsequently, there have been studies focused on preventing postoperative delirium to prevent various complications such as increased risk of dementia, prolonged length of hospital stay, extended recovery time, reduced ability to perform daily activities and increased mortality rate if patients experience postoperative delirium. The dose per hour of dexmedetomidine demonstrated in studies ranges from 0.1 to 1 mcg/kg/hr, which is a maintenance dosage that induces sedation during surgery. Common adverse events are bradycardia and hypotension.