Use Of Dexmedetomidine As A Sedative On ICU (Essay Sample)

Use of Dexmedetomidine as a Sedative on ICU
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Use of Dexmedetomidine as a Sedative on ICU
Introduction
Sedatives are a group of medications that are commonly prescribed to patients in intensive care units to manage agitation and anxiety, which can be caused by mechanical ventilation, lack of sleep, or pain. Sedatives work by suppressing the activity of the central nervous system, thus slowing down the normal brain function. Most sedatives provide a relaxing effect by acting on the gamma-aminobutyric acid (GABA) which is a neurotransmitter that transmits information between the brain cells. However, the use of some sedatives can lead to adverse conditions. The sedative can increase the length stay in ICU, delirium, coma and respiratory depression. With a lot of sedatives currently in use in hospitals, do ICU patients who receive dexmedetomidine (precedex) as a sedative experience less delirium than patients who do not. This paper analyzes the use of dexmedetomidine in ICU and the extent to which it causes delirium when compared to other sedatives.
Dexmedetomidine (Precedex)
Precedex is an alpha-2 receptor agonist medication that is commonly used as a sedative or an analgesic. Dexmedetomidine binds to the alpha-2 receptors in the brains and stimulates the sympathetic nervous system. The stimulation of the alpha-2 receptors results in a decreased release of norepinephrine from the neurons, thus reducing the sympathetic activity of the central nervous system (Barr et al., 2013). This eventually reduces the heart rate and provides relaxing feeling to the patient.
Use of Dexmedetomidine in ICU
Patients in intensive care units (ICU) can experience physical and psychological stresses such as pain, fear, and anxiety. Therefore, the use of sedative is crucial in managing them. Nurses routinely provide intravenous analgesics and sedatives such as dexmedetomidine to minimize the pain, anxiety, and stress of the patients and allow them to conduct invasive procedures.
Dexmedetomidine is commonly used in ICU as a short-term sedative because of its light sedation. Also, dexmedetomidine is preferred for use in ICU patients because of its additional analgesic and anxiolytic properties. Unlike other sedatives such as propofol and lorazepam, dexmedetomidine does not cause significant respiratory depression. Another reason why precedex is a preferred sedative in ICU is that patients on dexmedetomidine are aroused and can actively cooperate with the various procedures. The medication allows the patients to communicate and interact with nurses. Nurses can quickly wake patients from their sleep to conduct additional procedures for the duration of the medication.
Because of the above characteristics, dexmedetomidine has been used in ICU patients on mechanical ventilation before, during and after extubation. In ICU setting, nurses can initiate sedation by dexmedetomidine with a dose of 1 μg/kg. After 30 minutes, the nurse can then administer a dose of 0.2–0.7 μg/kg/h (Barr et al., 2013). However, the continuous injection should not exceed 24 hours (Barr et al., 2013). Infusion of dexmedetomidine beyond 24 hours can result in severe adverse cardiovascular conditions such as hypotension and bradycardia.
Dexmedetomidine and delirium
It is challenging to predict the pharmacokinetics and Pharmacodynamics of ICU patients due to the hemodynamic instability, and impaired organ function. Therefore, patients can easily suffer from harmful side effects of the sedatives. Delirium is a common mental problem that ICU patients experience. Approximately 80% of ICU patients have experienced delirium, resulting in higher incidences of mobility, death, hospital stay and respiratory problems (Barr et al., 2013). Studies have suggested that using dexmedetomidine as a sedative in ICU patients causes less delirium as compared to other sedatives.
Park et al. (2014) conducted a study on the number of delirium cases reported in postoperative ICU patients. He observed a significant difference in the incidences of delirium in patients treated with dexmedetomidine as compared to remifentanil. 6 of 67 in (8.96%) patients treated with dexmedetomidine experienced delirium while incidences of delirium ware reported in 17 of 75 (22.67%) of the patients that were treated with remifentanil (Park et al., 2014). However, the researcher did not observe any significant disparities between the two cohorts regarding the total length of ICU stay.
In another randomized pilot study on the ICU patients, MacLaren et al. (2015) reported incidences of delirium in 1 of 11 (9%) receiving dexmedetomidine as compared to 5 of 12 (41%) patients receiving midazolam. A randomized control study by Djaiani et al. (2016) has also demonstrated that dexmedetomidine causes less delirium in postoperative patients in ICU when compared to propofol. In the study, 16 of 91 (17.5%) and 29 of 92 (31.5%) patients experienced delirium when there were treated with dexmedetomidine and propofol respectively (Djaiani et al., 2016)
Another study by Jiang et al. (2016) has also reported that the use of dexmedetomidine in patients on mechanical ventilators and surgical ICUs reduces the incidences of delirium. In his study, 9 of 56 (16.1%) patients treated with dexmedetomidine experienced delirium while 11 of the 55 (20%) of the patients using propofol suffered from delirium. Rosenzweig and Sittambalam (2015) have also reported that 132 of the 244 (54%) mechanically ventilated ICU patients treated with dexmedetomidine experienced delirium verses 93 of 122 (76.6%) patients treated with midazolam (Jiang et al., 2016).
Delirium is a reversible psychological condition that results in mental dysfunction. Severe infections affecting most ICU patients can impair the normal brain function resulting in delirium. The patient can experience symptoms such as illusions, anxiety, anger, and agitation which can result in higher mortality, prolonged hospital stay, coma or death. Nurses can use sedatives such as lorazepam, dexmedetomidine to provide individualized sedation to various ICT patients.
The above studies have demonstrated that dexmedetomidine causes less delirium in critically ill patients under different intensive care settings as compared to other sedatives. Other sedatives such as propofol and midazolam act on the gamma-aminobutyric acid system in the brain to produce more profound sedation that can result in hypoventilation (respiratory depression) which is a risk factor for delirium. Hypoventilation reduces the amount of oxygen in the body. Therefore, the brain does not get enough oxygen, resulting in depression, restlessness, hallucinations, and confusion. However, dexmedetomidine produces its sedative effect by reducing the sympathetic activity (Jiang et al., 2016). Therefore, compared to other sedatives, dexmedetomidine causes less neurocognitive dysfunction. The patient can stay alert and active, thus reducing the chan...