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Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.

Publication ,  Journal Article
Hsu, Y-W; Cortinez, LI; Robertson, KM; Keifer, JC; Sum-Ping, ST; Moretti, EW; Young, CC; Wright, DR; Macleod, DB; Somma, J
Published in: Anesthesiology
November 2004

BACKGROUND: Dexmedetomidine, a highly selective alpha2-adrenoceptor agonist used for short-term sedation of mechanically ventilated patients, has minimal effect on ventilation. METHODS: This study compared the respiratory effect of dexmedetomidine to that of remifentanil. The authors measured and compared respiratory responses of six healthy male volunteers during (1) a stepwise target-controlled infusion of remifentanil, (2) a stepwise target-controlled infusion of dexmedetomidine, and (3) a pseudonatural sleep session. RESULTS: Compared with baseline, remifentanil infusions resulted in respiratory depression as evidenced by a decrease in respiratory rate and minute ventilation, respiratory acidosis, and apnea episodes resulting in desaturations. Remifentanil disturbed the natural pattern of breathing and flattened the distribution of ventilatory timing (inspiratory time/ventilatory cycle time). The respiratory effects of dexmedetomidine markedly contrasted with those of remifentanil. When compared with baseline, during dexmedetomidine infusions, the respiratory rate significantly increased, and the overall apnea/hypopnea index significantly decreased. The distribution of inspiratory time/ventilatory cycle time showed an increased peak. In addition, dexmedetomidine seemed to mimic some aspect of natural sleep. While the subjects were breathing a 5% CO2 mixture, hypercapnic arousal phenomena (documented by the Bispectral Index, the electroencephalogram, and sudden increase in the minute ventilation) were observed during dexmedetomidine infusions. Similar phenomena during natural sleep have been reported in the literature. CONCLUSIONS: In comparison with remifentanil, dexmedetomidine infusions (1) did not result in clinically significant respiratory depression, (2) decreased rather than increased the apnea/hypopnea index, and (3) exhibited some similarity with natural sleep.

Duke Scholars

Published In

Anesthesiology

DOI

ISSN

0003-3022

Publication Date

November 2004

Volume

101

Issue

5

Start / End Page

1066 / 1076

Location

United States

Related Subject Headings

  • Sleep
  • Respiratory Mechanics
  • Remifentanil
  • Piperidines
  • Oxygen
  • Male
  • Infusions, Intravenous
  • Hypnotics and Sedatives
  • Hypercapnia
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Hsu, Y.-W., Cortinez, L. I., Robertson, K. M., Keifer, J. C., Sum-Ping, S. T., Moretti, E. W., … Somma, J. (2004). Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology, 101(5), 1066–1076. https://doi.org/10.1097/00000542-200411000-00005
Hsu, Yung-Wei, Luis I. Cortinez, Kerri M. Robertson, John C. Keifer, Sam T. Sum-Ping, Eugene W. Moretti, Christopher C. Young, David R. Wright, David B. Macleod, and Jacques Somma. “Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiology 101, no. 5 (November 2004): 1066–76. https://doi.org/10.1097/00000542-200411000-00005.
Hsu Y-W, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, et al. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004 Nov;101(5):1066–76.
Hsu, Yung-Wei, et al. “Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers.Anesthesiology, vol. 101, no. 5, Nov. 2004, pp. 1066–76. Pubmed, doi:10.1097/00000542-200411000-00005.
Hsu Y-W, Cortinez LI, Robertson KM, Keifer JC, Sum-Ping ST, Moretti EW, Young CC, Wright DR, Macleod DB, Somma J. Dexmedetomidine pharmacodynamics: part I: crossover comparison of the respiratory effects of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology. 2004 Nov;101(5):1066–1076.

Published In

Anesthesiology

DOI

ISSN

0003-3022

Publication Date

November 2004

Volume

101

Issue

5

Start / End Page

1066 / 1076

Location

United States

Related Subject Headings

  • Sleep
  • Respiratory Mechanics
  • Remifentanil
  • Piperidines
  • Oxygen
  • Male
  • Infusions, Intravenous
  • Hypnotics and Sedatives
  • Hypercapnia
  • Humans