Zhao Yang, He Jianshuai, Yu Ning, Jia Changxin, Wang Shilei
Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Neurosci. 2020 May 5;14:330. doi: 10.3389/fnins.2020.00330. eCollection 2020.
Dexmedetomidin is a new-generation, highly selective α2 adrenergic receptor agonist with a large number of advantages, including its sedative and analgesic properties, its ability to inhibit sympathetic nerves, its reduced anesthetic dosage, its hemodynamic stability, its mild respiratory depression abilities, and its ability to improve postoperative recognition. Its safety and effectiveness, as well as its ability to provide a certain degree of comfort to patients, make it a useful anesthetic adjuvant for a wide range of clinical applications. For example, dexmedetomidine is commonly used in patients undergoing general anesthesia, and it also exerts sedative effects during tracheal intubation or mechanical ventilation in intensive care unit patients. In recent years, with the deepening of clinical research on dexmedetomidine, the drug is still applied in the treatment of spastic pain, myofascial pain, neuropathic pain, complex pain syndrome, and chronic headache, as well as for multimodal analgesia. However, we must note that the appropriateness of patient and dose selection should be given attention when using this drug; furthermore, patients should be observed for adverse reactions such as hypotension and bradycardia. Therefore, the safety and effectiveness of this drug for long-term use remain to be studied. In addition, basic experimental studies have also found that dexmedetomidine can protect important organs, such as the brain, heart, kidney, liver, and lung, through various mechanisms, such as antisympathetic effects, the inhibition of apoptosis and oxidative stress, and a reduction in the inflammatory response. Moreover, the neuroprotective properties of dexmedetomidine have received the most attention from scholars. Hence, in this review, we mainly focus on the characteristics and clinical applications of dexmedetomidine, especially the role of dexmedetomidine in the nervous system and the use of dexmedetomidine in the relief of neuropathic pain.
右美托咪定是新一代高选择性α2肾上腺素能受体激动剂，具有诸多优点，包括镇静、镇痛作用，抑制交感神经的能力，减少麻醉药物用量，血流动力学稳定，轻度呼吸抑制作用以及改善术后认知功能。其安全性和有效性，以及为患者提供一定程度舒适感的能力，使其成为广泛临床应用中有用的麻醉辅助药物。例如，右美托咪定常用于接受全身麻醉的患者，在重症监护病房患者气管插管或机械通气期间也发挥镇静作用。近年来，随着对右美托咪定临床研究的深入，该药物仍应用于治疗痉挛性疼痛、肌筋膜疼痛、神经性疼痛、复杂疼痛综合征和慢性头痛，以及用于多模式镇痛。然而，我们必须注意，使用该药物时应关注患者选择和剂量的适宜性；此外，应观察患者是否出现低血压和心动过缓等不良反应。因此，该药物长期使用的安全性和有效性仍有待研究。此外，基础实验研究还发现，右美托咪定可通过多种机制保护重要器官，如大脑、心脏、肾脏、肝脏和肺，这些机制包括抗交感神经作用、抑制细胞凋亡和氧化应激以及减轻炎症反应。而且，右美托咪定的神经保护特性受到了学者们的最多关注。因此，在本综述中，我们主要关注右美托咪定的特性和临床应用，特别是右美托咪定在神经系统中的作用以及右美托咪定在缓解神经性疼痛中的应用。
