Use of Dexmedetomidine in patients undergoing ambulatory anesthesia: a narrative review
Dexmedetomidine, Ambulatory care, Ambulatory surgical procedures, Outpatients
Published online: May 17 2024
Abstract
Background: Dexmedetomidine (DEX) is a potent alpha-2 adrenoceptor agonist with a high degree of selectivity. Its pharmacologic effects include sedation, anxiolysis, analgesia, sympatholysis, opioid-sparing properties and preservation of respiratory function, making it suitable for sedation and analgesia throughout the perioperative period. Ambulatory anesthesia concerns all patients who require anesthesia for a procedure or surgery without requiring an overnight hospital stay. In this setting and due to its properties, DEX may be beneficial. The aim of this narrative review is to draw a picture of the potential indications for the use of DEX in current outpatient practice.
Materials and methods: PubMed and Embase were searched for relevant articles from January 1, 2008, to January 31, 2023. Studies were eligible for inclusion if they reported the use of DEX in adults or children receiving any type of anesthesia for outpatient procedures.
Results: After screening the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, 104 studies were retained for the final analysis.
Conclusion: The currently available literature supports the safety and efficacy of DEX in ambulatory anesthesia. Its use as premedication, as an anesthetic adjunct to general and regional anesthesia, and as a postoperative analgesic has demonstrated its benefits. Its use in children has shown great interest, especially in the prevention of emergence delirium. These advantages must be weighed against several disadvantages of DEX administration, such as potentially prolonged induction and recovery times, high price, and lack of a reversal agent. In the ambulatory care setting, the use of DEX must be done under the supervision of a professional who knows the advantages and disadvantages of the molecule in this context, and patients should be informed of post-procedure safety measures to follow after hospital discharge.
