Iirola Timo, Laitio Ruut, Kentala Erkki, Aantaa Riku, Kurvinen Juha-Pekka, Scheinin Mika, Olkkola Klaus T
Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku and Turku University Hospital, FIN-20521, Turku, Finland.
J Med Case Rep. 2010 Feb 25;4:73. doi: 10.1186/1752-1947-4-73.
Dexmedetomidine is a selective and potent alpha2-adrenoceptor agonist licensed for use in the sedation of patients initially ventilated in intensive care units at a maximum dose rate of 0.7 mug/kg/h administered for up to 24 hours. Higher dose rates and longer infusion periods are sometimes required to achieve sufficient sedation. There are some previous reports on the use of long-term moderate to high-dose infusions of dexmedetomidine in patients in intensive care units, but none of these accounts have cited dexmedetomidine plasma concentrations.
We describe the case of a 42-year-old Caucasian woman with severe hemorrhagic pancreatitis following laparoscopic cholecystectomy who received dexmedetomidine for 24 consecutive days at a maximum dose rate of 1.9 mug/kg/h. Samples for the measurement of dexmedetomidine concentrations in her plasma were drawn at intervals of eight hours. On average, the observed plasma concentrations were well in accordance with previous knowledge on the pharmacokinetics of dexmedetomidine. There was, however, marked variability in the concentration of dexmedetomidine in her plasma despite a stable infusion rate.
The pharmacokinetics of dexmedetomidine appears to be highly variable during intensive care.
右美托咪定是一种选择性强效α2肾上腺素能受体激动剂，已获许可用于重症监护病房中初始接受机械通气患者的镇静，最大剂量率为0.7微克/千克/小时，给药时间长达24小时。有时需要更高的剂量率和更长的输注时间才能实现充分镇静。此前有一些关于在重症监护病房患者中使用长期中等至高剂量右美托咪定输注的报道，但这些报道均未提及右美托咪定的血浆浓度。
我们描述了一名42岁的白种女性患者，在腹腔镜胆囊切除术后发生严重出血性胰腺炎，接受了连续24天的右美托咪定治疗，最大剂量率为1.9微克/千克/小时。每隔8小时采集她的血浆样本以测定右美托咪定浓度。平均而言，观察到的血浆浓度与先前关于右美托咪定药代动力学的知识相符。然而，尽管输注速率稳定，但她血浆中的右美托咪定浓度仍存在显著差异。
在重症监护期间，右美托咪定的药代动力学似乎高度可变。
