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What Is the Role of Dexmedetomidine in Modern Anesthesia and Critical Care?

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      References

        • Mahmoud M.
        • Barbi E.
        • Mason K.P.
        Dexmedetomidine: What's New for Pediatrics? A Narrative Review.
        J Clin Med. 2020; 9https://doi.org/10.3390/jcm9092724
        • Kohli J.K.
        • Magoon R.
        • Dey S.
        • et al.
        Evolving spectrum of dexmedetomidine preconditioning for Ischemia-reperfusion injury amelioration.
        J Anaesthesiol Clin Pharmacol. 2020; 36: 272-273
        • Pasin L.
        • Febres D.
        • Testa V.
        • et al.
        Dexmedetomidine vs midazolam as preanesthetic medication in children: a meta-analysis of randomized controlled trials.
        Paediatr Anaesth. 2015; 25: 468-476
        • Jun J.H.
        • Kim K.N.
        • Kim J.Y.
        • et al.
        The effects of intranasal dexmedetomidine premedication in children: a systematic review and meta-analysis.
        Can J Anaesth. 2017; 64 (Les effets d'une premedication intranasale de dexmedetomidine chez l'enfant : revue systematique et meta-analyse): 947-961
        • Walker K.J.
        • Smith A.F.
        Premedication for anxiety in adult day surgery.
        Cochrane Database Syst Rev. 2009; : CD002192
        • Yuen V.M.
        • Irwin M.G.
        • Hui T.W.
        • et al.
        A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine.
        Anesth Analg. 2007; 105: 374-380
        • Nooh N.
        • Sheta S.A.
        • Abdullah W.A.
        • et al.
        Intranasal atomized dexmedetomidine for sedation during third molar extraction.
        Int J Oral Maxillofac Surg. 2013; 42: 857-862
        • Lu C.
        • Zhang L.M.
        • Zhang Y.
        • et al.
        Intranasal Dexmedetomidine as a Sedative Premedication for Patients Undergoing Suspension Laryngoscopy: A Randomized Double-Blind Study.
        PLoS One. 2016; 11e0154192
        • Barends C.R.M.
        • Driesens M.K.
        • Struys M.
        • et al.
        Intranasal dexmedetomidine in elderly subjects with or without beta blockade: a randomised double-blind single-ascending-dose cohort study.
        Br J Anaesth. 2020; : 3https://doi.org/10.1016/j.bja.2019.12.025
        • Rao Y.
        • Zeng R.
        • Jiang X.
        • et al.
        The Effect of Dexmedetomidine on Emergence Agitation or Delirium in Children After Anesthesia-A Systematic Review and Meta-Analysis of Clinical Studies.
        Front Pediatr. 2020; 8: 329https://doi.org/10.3389/fped.2020.00329
        • Lian X.
        • Lin Y.
        • Luo T.
        • et al.
        Comparison of dexmedetomidine with chloral hydrate as sedatives for pediatric patients: A systematic review and meta-analysis.
        Medicine (Baltimore). 2020; 99e21008https://doi.org/10.1097/MD.0000000000021008
        • Miller J.W.
        • Balyan R.
        • Dong M.
        • et al.
        Does intranasal dexmedetomidine provide adequate plasma concentrations for sedation in children: a pharmacokinetic study.
        Br J Anaesth. 2018; 120: 1056-1065
        • Li B.L.
        • Zhang N.
        • Huang J.X.
        • et al.
        A comparison of intranasal dexmedetomidine for sedation in children administered either by atomiser or by drops.
        Anaesthesia. May 2016; 71: 522-528
        • Mason K.P.
        • O'Mahony E.
        • Zurakowski D.
        • et al.
        Effects of dexmedetomidine sedation on the EEG in children.
        Paediatr Anaesth. 2009; 19: 1175-1183
        • Souter M.J.
        • Rozet I.
        • Ojemann J.G.
        • et al.
        Dexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography.
        J Neurosurg Anesthesiol. 2007; 19: 38-44
        • Godbehere J.
        • Harper S.
        • Loxey T.
        • et al.
        Auditory brainstem response testing using intranasal dexmedetomidine sedation in children: a pilot study.
        Int J Audiol. 2021; 60: 549-554
        • Li B.L.
        • Yuen V.M.
        • Zhou J.L.
        • et al.
        A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children.
        Paediatr Anaesth. 2018; 28: 1022-1028
        • Barends C.R.
        • Absalom A.
        • van Minnen B.
        • et al.
        Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety.
        PLoS One. 2017; 12e0169525
        • Subsoontorn P.
        • Lekprasert V.
        • Waleeprakhon P.
        • et al.
        Premedication with dexmedetomidine for prevention of hyperdynamic response after electroconvulsive therapy: a cross-over, randomized controlled trial.
        BMC Psychiatry. 2021; 21: 408
        • Parikh D.A.
        • Garg S.N.
        • Dalvi N.P.
        • et al.
        Outcome of four pretreatment regimes on hemodynamics during electroconvulsive therapy: A double-blind randomized controlled crossover trial.
        Ann Card Anaesth. 2017; 20: 93-99
        • Tang Z.H.
        • Chen Q.
        • Wang X.
        • et al.
        A systematic review and meta-analysis of the safety and efficacy of remifentanil and dexmedetomidine for awake fiberoptic endoscope intubation.
        Medicine (Baltimore). 2021; 100e25324
        • Bergese S.D.
        • Patrick Bender S.
        • McSweeney T.D.
        • et al.
        A comparative study of dexmedetomidine with midazolam and midazolam alone for sedation during elective awake fiberoptic intubation.
        J Clin Anesth. 2010; 22: 35-40
        • Johnston K.D.
        • Rai M.R.
        Conscious sedation for awake fibreoptic intubation: a review of the literature.
        Can J Anaesth. 2013; 60: 584-599
        • Chu K.S.
        • Wang F.Y.
        • Hsu H.T.
        • et al.
        The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation.
        Eur J Anaesthesiol. 2010; 27: 36-40
        • Mahmoud M.
        • Gunter J.
        • Donnelly L.F.
        • et al.
        A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children.
        Anesth Analg. 2009; 109: 745-753
        • Kandil A.
        • Subramanyam R.
        • Hossain M.M.
        • et al.
        Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children.
        Paediatr Anaesth. 2016; 26: 742-751
        • Mahmoud M.
        • Jung D.
        • Salisbury S.
        • et al.
        Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea.
        J Clin Anesth. 2013; 25: 529-541
        • Tasbihgou S.R.
        • Barends C.R.M.
        • Absalom A.R.
        The role of dexmedetomidine in neurosurgery.
        Best Pract Res Clin Anaesthesiol. 2021; 35: 221-229
        • Grant R.
        • Gruenbaum S.E.
        • Gerrard J.
        Anaesthesia for deep brain stimulation: a review.
        Curr Opin Anaesthesiol. 2015; 28: 505-510
        • Elias W.J.
        • Durieux M.E.
        • Huss D.
        • et al.
        Dexmedetomidine and arousal affect subthalamic neurons.
        Mov Disord. 2008; 23: 1317-1320
        • Zhang Z.
        • Ferretti V.
        • Guntan I.
        • et al.
        Neuronal ensembles sufficient for recovery sleep and the sedative actions of alpha2 adrenergic agonists.
        Nat Neurosci. 2015; 18: 553-561
        • Ge Y.L.
        • Li X.
        • Gao J.U.
        • et al.
        Beneficial effects of intravenous dexmedetomidine on cognitive function and cerebral injury following a carotid endarterectomy.
        Exp Ther Med. 2016; 11: 1128-1134
        • Pacreu S.
        • Vila E.
        • Molto L.
        • et al.
        Effect of dexmedetomidine on evoked-potential monitoring in patients undergoing brain stem and supratentorial cranial surgery.
        Acta Anaesthesiol Scand. 2021; 65: 1043-1053
        • Mahmoud M.
        • Sadhasivam S.
        • Salisbury S.
        • et al.
        Susceptibility of transcranial electric motor-evoked potentials to varying targeted blood levels of dexmedetomidine during spine surgery.
        Anesthesiology. 2010; 112: 1364-1373
        • Turan A.
        • Duncan A.
        • Leung S.
        • et al.
        Dexmedetomidine for reduction of atrial fibrillation and delirium after cardiac surgery (DECADE): a randomised placebo-controlled trial.
        Lancet. 2020; 396: 177-185
        • Geng J.
        • Qian J.
        • Cheng H.
        • et al.
        The Influence of Perioperative Dexmedetomidine on Patients Undergoing Cardiac Surgery: A Meta-Analysis.
        PLoS One. 2016; 11e0152829
        • Ghimire L.V.
        • Chou F.S.
        Efficacy of prophylactic dexmedetomidine in preventing postoperative junctional ectopic tachycardia in pediatric cardiac surgery patients: A systematic review and meta-analysis.
        Paediatr Anaesth. 2018; 28: 597-606
        • Pan W.
        • Wang Y.
        • Lin L.
        • et al.
        Outcomes of dexmedetomidine treatment in pediatric patients undergoing congenital heart disease surgery: a meta-analysis.
        Paediatr Anaesth. 2016; 26: 239-248
        • Sun M.
        • Liu H.
        • Yu Q.
        • et al.
        A Comparison of Intranasal Dexmedetomidine and Dexmedetomidine-Ketamine Combination Sedation for Transthoracic Echocardiography in Pediatric Patients With Congenital Heart Disease: A Randomized Controlled Trial.
        J Cardiothorac Vasc Anesth. 2020; 34: 1550-1555
        • Hasanin A.
        • Taha K.
        • Abdelhamid B.
        • et al.
        Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease.
        BMC Anesthesiol. 2018; 18: 104
        • Xu B.
        • Gao H.
        • Li D.
        • et al.
        Nebulized dexmedetomidine improves pulmonary shunt and lung mechanics during one-lung ventilation: a randomized clinical controlled trial.
        PeerJ. 2020; 8: e9247
        • Chen R.
        • Kang Z.
        • Wang Y.
        • et al.
        The Anti-inflammatory Effect of Dexmedetomidine Administration on Patients Undergoing Intestinal Surgery: A Randomized Study.
        Drugs R D. 2021; 21: 445-453
        • Li M.
        • Wang T.
        • Xiao W.
        • et al.
        Low-Dose Dexmedetomidine Accelerates Gastrointestinal Function Recovery in Patients Undergoing Lumbar Spinal Fusion.
        Front Pharmacol. 2019; 10: 1509
        • Fayed N.A.
        • Sayed E.I.
        • Saleh S.M.
        • et al.
        Effect of dexmedetomidine on hepatic ischemia-reperfusion injury in the setting of adult living donor liver transplantation.
        Clin Transpl. 2016; 30: 470-482
        • Chen J.
        • Perez R.
        • de Mattos A.M.
        • et al.
        Perioperative Dexmedetomidine Improves Outcomes of Kidney Transplant.
        Clin Transl Sci. 2020; 13: 1279-1287
        • Zhang L.
        • Li N.
        • Cui L.L.
        • et al.
        Intraoperative Low-Dose Dexmedetomidine Administration Associated with Reduced Hepatic Ischemia-Reperfusion Injury in Pediatric Deceased Liver Transplantation: A Retrospective Cohort Study.
        Ann Transplant. 2021; 26e933354https://doi.org/10.12659/AOT.933354
        • Andropoulos D.B.
        Effect of Anesthesia on the Developing Brain: Infant and Fetus.
        Fetal Diagn Ther. 2018; 43: 1-11
        • Shan Y.
        • Sun S.
        • Yang F.
        • et al.
        Dexmedetomidine protects the developing rat brain against the neurotoxicity wrought by sevoflurane: role of autophagy and Drp1-Bax signaling.
        Drug Des Devel Ther. 2018; 12: 3617-3624
        • Nishizawa T.
        • Suzuki H.
        • Sagara S.
        • et al.
        Dexmedetomidine versus midazolam for gastrointestinal endoscopy: a meta-analysis.
        Dig Endosc. 2015; 27: 8-15
        • Fonseca F.J.
        • Ferreira L.
        • Rouxinol-Dias A.L.
        • et al.
        Effects of dexmedetomidine in non-operating room anesthesia in adults: a systematic review with meta-analysis.
        Braz J Anesthesiol. 2021; https://doi.org/10.1016/j.bjane.2021.12.002
        • Obara S.
        • Morimoto I.
        • Iseki Y.
        • et al.
        The Effect of Obesity on Dose of Dexmedetomidine When Administered with Fentanyl during Postoperative Mechanical Ventilation--Retrospective.
        Fukushima J Med Sci. 2015; 61: 38-46
        • Xu B.
        • Zhou D.
        • Ren L.
        • et al.
        Pharmacokinetic and pharmacodynamics of intravenous dexmedetomidine in morbidly obese patients undergoing laparoscopic surgery.
        J Anesth. 2017; 31: 813-820
        • Cortinez L.I.
        • Anderson B.J.
        • Holford N.H.
        • et al.
        Dexmedetomidine pharmacokinetics in the obese.
        Eur J Clin Pharmacol. 2015; 71: 1501-1508
        • Rolle A.
        • Paredes S.
        • Cortinez L.I.
        • et al.
        Dexmedetomidine metabolic clearance is not affected by fat mass in obese patients.
        Br J Anaesth. 2018; 120: 969-977
        • Ingrande J.
        • Lemmens H.J.
        Dose adjustment of anaesthetics in the morbidly obese.
        Br J Anaesth. 2010; 105 (i16–23)
        • Corcuera-Flores J.R.
        • Silvestre-Rangil J.
        • Cutando-Soriano A.
        • et al.
        Current methods of sedation in dental patients - a systematic review of the literature.
        Med Oral Patol Oral Cir Bucal. 2016; 21: e579-e586
        • Oriby M.E.
        Comparison of Intranasal Dexmedetomidine and Oral Ketamine Versus Intranasal Midazolam Premedication for Children Undergoing Dental Rehabilitation.
        Anesth Pain Med. 2019; 9e85227
        • Zanaty O.M.
        • El Metainy S.A.
        A comparative evaluation of nebulized dexmedetomidine, nebulized ketamine, and their combination as premedication for outpatient pediatric dental surgery.
        Anesth Analg. 2015; 121: 167-171
        • Mei B.
        • Meng G.
        • Xu G.
        • et al.
        Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty: A Prospective Randomized Controlled Study.
        Clin J Pain. 2018; 34: 811-817
        • Wang Q.
        • Li H.
        • Wei S.
        • et al.
        Dexmedetomidine Added to Ropivacaine for Ultrasound-guided Erector Spinae Plane Block Prolongs Analgesia Duration and Reduces Perioperative Opioid Consumption After Thoracotomy: A Randomized, Controlled Clinical Study.
        Clin J Pain. 2021; 38: 8-14
        • Moshiri E.
        • Modir H.
        • Kamali A.
        • et al.
        Comparative analgesic, hemodynamic, pain and duration of sensory and motor block effects of dexmedetomidine, granisetron, and nitroglycerin added to ropivacaine in intravenous anesthesia for forearm surgeries: a randomized clinical study.
        Med Gas Res. 2022; 12: 77-82
        • Vorobeichik L.
        • Brull R.
        • Abdallah F.W.
        Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials.
        Br J Anaesth. 2017; 118: 167-181
        • Cai H.
        • Fan X.
        • Feng P.
        • et al.
        Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and Meta-analysis of 57 randomized clinical trials.
        BMC Anesthesiol. 2021; 21: 233
        • Duncan D.
        • Sankar A.
        • Beattie W.S.
        • et al.
        Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery.
        Cochrane Database Syst Rev. 2018; 3: CD004126
        • Gallego-Ligorit L.
        • Vives M.
        • Valles-Torres J.
        • et al.
        Use of Dexmedetomidine in Cardiothoracic and Vascular Anesthesia.
        J Cardiothorac Vasc Anesth. 2018; 32: 1426-1438
        • Aono J.
        • Ueda W.
        • Mamiya K.
        • et al.
        Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys.
        Anesthesiology. 1997; 87: 1298-1300
        • Uezono S.
        • Goto T.
        • Terui K.
        • et al.
        Emergence agitation after sevoflurane versus propofol in pediatric patients.
        Anesth Analg. 2000; 91: 563-566
        • Przybylo H.J.
        • Martini D.R.
        • Mazurek A.J.
        • et al.
        Assessing behaviour in children emerging from anaesthesia: can we apply psychiatric diagnostic techniques?.
        Paediatr Anaesth. 2003; 13: 609-616
        • Vlajkovic G.P.
        • Sindjelic R.P.
        Emergence delirium in children: many questions, few answers.
        Anesth Analg. 2007; 104: 84-91
        • Wei B.
        • Feng Y.
        • Chen W.
        • et al.
        Risk factors for emergence agitation in adults after general anesthesia: A systematic review and meta-analysis.
        Acta Anaesthesiol Scand. 2021; 65: 719-729
        • Mason K.P.
        Paediatric emergence delirium: a comprehensive review and interpretation of the literature.
        Br J Anaesth. 2017; 118: 335-343
        • Yang X.
        • Hu Z.
        • Peng F.
        • et al.
        Effects of Dexmedetomidine on Emergence Agitation and Recovery Quality Among Children Undergoing Surgery Under General Anesthesia: A Meta-Analysis of Randomized Controlled Trials.
        Front Pediatr. 2020; 8580226
        • Sun L.
        • Guo R.
        • Sun L.
        Dexmedetomidine for preventing sevoflurane-related emergence agitation in children: a meta-analysis of randomized controlled trials.
        Acta Anaesthesiol Scand. 2014; 58: 642-650
        • Zhang Y.Z.
        • Wang X.
        • Wu J.M.
        • et al.
        Optimal Dexmedetomidine Dose to Prevent Emergence Agitation Under Sevoflurane and Remifentanil Anesthesia During Pediatric Tonsillectomy and Adenoidectomy.
        Front Pharmacol. 2019; 10: 1091https://doi.org/10.3389/fphar.2019.01091
        • Hauber J.A.
        • Davis P.J.
        • Bendel L.P.
        • et al.
        Dexmedetomidine as a Rapid Bolus for Treatment and Prophylactic Prevention of Emergence Agitation in Anesthetized Children.
        Anesth Analg. 2015; 121: 1308-1315
        • Sun M.
        • Peng T.
        • Sun Y.
        • et al.
        Intraoperative use of low-dose dexmedetomidine for the prevention of emergence agitation following general anaesthesia in elderly patients: a randomized controlled trial.
        Aging Clin Exp Res. 2021; https://doi.org/10.1007/s40520-021-01984-y
        • Liu J.
        • Wang Y.
        • Ma W.
        Shivering prevention and treatment during cesarean delivery under neuraxial anesthesia: a systematic review.
        Minerva Anestesiol. 2018; 84: 1393-1405
        • Hoffman J.
        • Hamner C.
        Effectiveness of dexmedetomidine use in general anesthesia to prevent postoperative shivering: a systematic review.
        JBI Database Syst Rev Implement Rep. 2016; 13: 287-313
        • Wang Y.Q.
        • Zhang X.J.
        • Wang Y.
        Effect of intrathecal dexmedetomidine on cesarean section during spinal anesthesia: a meta-analysis of randomized trials.
        Drug Des Devel Ther. 2019; 13: 2933-2939
        • Wang J.
        • Wang Z.
        • Liu J.
        • et al.
        Intravenous dexmedetomidine versus tramadol for treatment of shivering after spinal anesthesia: a meta-analysis of randomized controlled trials.
        BMC Anesthesiol. 2020; 20: 104
        • Kim Y.S.
        • Kim Y.I.
        • Seo K.H.
        • et al.
        Optimal dose of prophylactic dexmedetomidine for preventing postoperative shivering.
        Int J Med Sci. 2013; 10: 1327-1332
        • Yu G.
        • Jin S.
        • Chen J.
        • et al.
        The effects of novel alpha2-adrenoreceptor agonist dexmedetomidine on shivering in patients underwent caesarean section.
        Biosci Rep. 2019; 28: 39https://doi.org/10.1042/BSR20181847
        • West N.
        • Görges M.
        • Poznikoff A.
        • et al.
        Association of dexmedetomidine with recovery room and hospital discharge times: A retrospective cohort analysis.
        Paediatr Anaesth. 2021; 31: 1170-1178
        • Ma H.
        • Wachtendorf L.J.
        • Santer P.
        • et al.
        The effect of intraoperative dexmedetomidine administration on length of stay in the post-anesthesia care unit in ambulatory surgery: A hospital registry study.
        J Clin Anesth. 2021; 72110284
        • Xu C.
        • Zhang Y.
        • Zhang T.
        • et al.
        Efficacy and Safety of Intranasal Dexmedetomidine During Recovery From Sevoflurane Anesthesia in Children: A Systematic Review and Meta-analysis.
        Clin Neuropharmacol. 2021; 44: 157-168
        • Sin J.C.K.
        • Tabah A.
        • MJJ Campher
        • et al.
        The Effect of Dexmedetomidine on Postanesthesia Care Unit Discharge and Recovery: A Systematic Review and Meta-Analysis.
        Anesth Analg. 2022; https://doi.org/10.1213/ane.0000000000005843
      1. FDA. Dexmedetomidine package insert.
        (Available at:) (Accessed March 8 2022)
        • Sperotto F.
        • Mondardini M.C.
        • Dell'Oste C.
        • et al.
        Efficacy and Safety of Dexmedetomidine for Prolonged Sedation in the PICU: A Prospective Multicenter Study (PROSDEX).
        Pediatr Crit Care Med. 2020; 21: 625-636
        • Shutes B.L.
        • Gee S.W.
        • Sargel C.L.
        • et al.
        Dexmedetomidine as Single Continuous Sedative During Noninvasive Ventilation: Typical Usage, Hemodynamic Effects, and Withdrawal.
        Pediatr Crit Care Med. 2018; 19: 287-297
        • Daverio M.
        • Sperotto F.
        • Zanetto L.
        • et al.
        Dexmedetomidine for Prolonged Sedation in the PICU: A Systematic Review and Meta-Analysis.
        Pediatr Crit Care Med. 2020; 21: e467-e474
        • Constantin J.M.
        • Momon A.
        • Mantz J.
        • et al.
        Efficacy and safety of sedation with dexmedetomidine in critical care patients: a meta-analysis of randomized controlled trials.
        Anaesth Crit Care Pain Med. 2016; 35: 7-15
        • Cruickshank M.
        • Henderson L.
        • MacLennan G.
        • et al.
        Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review.
        Health Technol Assess Mar. 2016; 20 (v-xx): 1-117
        • Chen K.
        • Lu Z.
        • Xin Y.C.
        • et al.
        Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients.
        Cochrane Database Syst Rev. 2015; 1: Cd010269
        • Lewis K.
        • Piticaru J.
        • Chaudhuri D.
        • et al.
        Safety and Efficacy of Dexmedetomidine in Acutely Ill Adults Requiring Noninvasive Ventilation: A Systematic Review and Meta-analysis of Randomized Trials.
        Chest. 2021; 159: 2274-2288
        • Bouajram R.H.
        • Bhatt K.
        • Croci R.
        • et al.
        Incidence of Dexmedetomidine Withdrawal in Adult Critically Ill Patients: A Pilot Study.
        Crit Care Explor. 2019; 1e0035
        • Glaess S.S.
        • Attridge R.L.
        • Christina Gutierrez G.
        Clonidine as a strategy for discontinuing dexmedetomidine sedation in critically ill patients: A narrative review.
        Am J Health Syst Pharm. 2020; 77: 515-522
        • Berrens Z.J.
        • Sauro A.L.
        • Tillman E.M.
        Prevention of Withdrawal in Pediatric Patients Receiving Long-term Dexmedetomidine Infusions.
        J Pediatr Pharmacol Ther. 2021; 26: 81-86
        • Cioccari L.
        • Luethi N.
        • Bailey M.
        • et al.
        The effect of dexmedetomidine on vasopressor requirements in patients with septic shock: a subgroup analysis of the Sedation Practice in Intensive Care Evaluation [SPICE III] Trial.
        Crit Care. 2020; 24: 441
        • Morelli A.
        • Sanfilippo F.
        • Arnemann P.
        • et al.
        The Effect of Propofol and Dexmedetomidine Sedation on Norepinephrine Requirements in Septic Shock Patients: A Crossover Trial.
        Crit Care Med. 2019; 47: e89-e95
        • Wu M.
        • Liang Y.
        • Dai Z.
        • et al.
        Perioperative dexmedetomidine reduces delirium after cardiac surgery: A meta-analysis of randomized controlled trials.
        J Clin Anesth. 2018; 50: 33-42
        • Pereira J.V.
        • Sanjanwala R.M.
        • Mohammed M.K.
        • et al.
        Dexmedetomidine versus propofol sedation in reducing delirium among older adults in the ICU: A systematic review and meta-analysis.
        Eur J Anaesthesiol. 2020; 37: 121-131
        • Soltani F.
        • Tabatabaei S.
        • Jannatmakan F.
        • et al.
        Comparison of the Effects of Haloperidol and Dexmedetomidine on Delirium and Agitation in Patients with a Traumatic Brain Injury Admitted to the Intensive Care Unit.
        Anesth Pain Med. 2021; 11e113802
        • Skrobik Y.
        • Duprey M.S.
        • Hill N.S.
        • et al.
        Low-Dose Nocturnal Dexmedetomidine Prevents ICU Delirium. A Randomized, Placebo-controlled Trial.
        Am J Respir Crit Care Med. 2018; 197: 1147-1156
        • Deiner S.
        • Luo X.
        • Lin H.M.
        • et al.
        Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial.
        JAMA Surg. 2017; 152e171505
        • Dixit D.
        • Endicott J.
        • Burry L.
        • et al.
        Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients.
        Pharmacotherapy. 2016; 36: 797-822
        • Hofherr M.L.
        • Abrahm J.L.
        • Rickerson E.
        Dexmedetomidine: A Novel Strategy for Patients with Intractable Pain, Opioid-Induced Hyperalgesia, or Delirium at the End of Life.
        J Palliat Med. 2020; 23: 1515-1517
        • Burns J.
        • Jackson K.
        • Sheehy K.A.
        • et al.
        The Use of Dexmedetomidine in Pediatric Palliative Care: A Preliminary Study.
        J Palliat Med. 2017; 20: 779-783
        • Kent C.D.
        • Kaufman B.S.
        • Lowy J.
        Dexmedetomidine facilitates the withdrawal of ventilatory support in palliative care.
        Anesthesiology. 2005; 103: 439-441
        • De Zen L.
        • Della Paolera S.
        • Del Rizzo I.
        • et al.
        Home Intranasal Dexmedetomidine for Refractory Dystonia in Pediatric Palliative Care.
        J Pain Symptom Manage. 2020; 59: e3-e5
        • Ferguson L.
        • Wilson M.
        Intranasal dexmedetomidine: Procedural sedation in palliative care: A case report.
        Palliat Med. 2021; 35: 1625-1628
        • Laroche J.P.
        Subcutaneous dexmedetomidine for baclofen withdrawal during palliative sedation.
        BMJ Support Palliat Care. 2020; 10: 7-9
        • Thomas B.
        • Lo W.A.
        • Nangati Z.
        • et al.
        Dexmedetomidine for hyperactive delirium at the end of life: An open-label single arm pilot study with dose escalation in adult patients admitted to an inpatient palliative care unit.
        Palliat Med. 2021; 35: 729-737
        • Mason K.P.
        • Zgleszewski S.
        • Forman R.E.
        • et al.
        An exaggerated hypertensive response to glycopyrrolate therapy for bradycardia associated with high-dose dexmedetomidine.
        Anesth Analg. 2009; 108: 906-908
        • Congdon J.M.
        • Marquez M.
        • Niyom S.
        • et al.
        Evaluation of the sedative and cardiovascular effects of intramuscular administration of dexmedetomidine with and without concurrent atropine administration in dogs.
        J Am Vet Med Assoc. 2011; 239: 81-89
        • Subramanyam R.
        • Cudilo E.M.
        • Hossain M.M.
        • et al.
        To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in Pediatric Imaging.
        Anesth Analg. 2015; 121: 479-485
        • Wu X.
        • Hang L.H.
        • Wang H.
        • et al.
        Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia.
        Yonsei Med J. 2016; 57: 998-1005
        • Naaz S.
        • Bandey J.
        • Ozair E.
        • et al.
        Optimal Dose of Intrathecal Dexmedetomidine in Lower Abdominal Surgeries in Average Indian Adult.
        J Clin Diagn Res. 2016; 10 (UC09–13)
        • Gupta R.
        • Bogra J.
        • Verma R.
        • et al.
        Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia.
        Indian J Anaesth. 2011; 55: 347-351
        • Abdel-Ghaffar H.S.
        • Mohamed S.A.
        • Fares K.M.
        • et al.
        Safety and Efficacy of Dexmedetomidine in Treating Post Spinal Anesthesia Shivering: A Randomized Clinically Controlled Dose-Finding Trial.
        Pain Physician. 2016; 19: 243-253