Department of Pharmacy, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
J Crit Care. 2009 Dec;24(4):568-74. doi: 10.1016/j.jcrc.2009.05.015. Epub 2009 Aug 13.
Although no ideal sedative exists, dexmedetomidine is unique because it produces sedation and analgesia without decreasing the respiratory drive. Hemodynamic responses to dexmedetomidine are variable and dependent on the patient population. Our initial experience was associated with an unacceptable incidence of hypotension and bradycardia. We evaluated occurrence of hypotension and bradycardia in critically ill surgical patients receiving dexmedetomidine before and after implementation of a dosing protocol.
This is a retrospective chart review of all admissions to a university medical center-based, 44-bed surgical intensive care unit pre and post protocol implementation.
Forty-four patients received dexmedetomidine including 19 historic controls and 25 dosed via protocol. Both groups had comparable demographics and initial and maximum dosages of dexmedetomidine. Use of the dosing protocol resulted in fewer dosage changes (mean +/- standard deviation, 4.8 +/- 3.8 compared to 7.8 +/- 3.9; P = .014) and fewer episodes of hypotension (16% vs 68.4%; P = .0006) but did not influence bradycardic episodes (20% vs 15.5%; P > .99).
We found that use of a protocol that increases the time interval between dosage adjustments may reduce dexmedetomidine-associated hypotension.
虽然没有理想的镇静剂，但右美托咪定是独特的，因为它在不降低呼吸驱动力的情况下产生镇静和镇痛作用。右美托咪定的血流动力学反应是可变的，并取决于患者人群。我们最初的经验与不可接受的低血压和心动过缓发生率有关。我们评估了在实施剂量方案前后接受右美托咪定的危重症外科患者低血压和心动过缓的发生情况。
这是对大学医学中心 44 张外科重症监护病房（SICU）入住患者进行的回顾性图表审查，包括方案实施前后。
44 例患者接受右美托咪定治疗，包括 19 例历史对照和 25 例按方案剂量。两组患者的人口统计学特征、初始和最大右美托咪定剂量均相似。使用剂量方案导致剂量变化减少（平均值 +/- 标准差，4.8 +/- 3.8 与 7.8 +/- 3.9；P =.014）和低血压发作减少（16% 与 68.4%；P =.0006），但不影响心动过缓发作（20% 与 15.5%；P >.99）。
我们发现，使用增加剂量调整时间间隔的方案可能会降低右美托咪定相关的低血压。
