UMEM Educational Pearls

Dexmedetomidine and the Critically Ill

  • Dexmedetomidine is a newer sedative agent that is being used with increasing frequency in the critically ill
  • A few pieces of information regarding dexmedetomidine:
    • highly selective alpha-2 agonist
    • produces dose-dependent sedation and anxiolysis while maintaining arousability at deep levels of sedation (hypercapnic arousal is preserved)
    • onset of action is approximately 15 minutes with peak concentration achieved in about 1 hour
    • metabolized via the liver
    • no known active or toxic metabolites
    • loading dose of 1 mcg/kg over 10 minutes followed by 0.2 - 0.7 mcg/kg/hr
  • Primary side effect is bradycardia at excessive doses
  • Cost is an issue when compared to propofol and midazolam


Panzer O, Moitra V, Sladen RN. Pharmacology of sedative-analgesic agents: dexmedetomidine, remifentanil, ketamine, volatile anesthetics, and the role of peripheral mu antagonists. Crit Care Clin 2009;25:451-69.