Pain Research and Management,
Journal Year:
2024,
Volume and Issue:
2024(1)
Published: Jan. 1, 2024
Background:
Cancer‐related
pain
is
a
pervasive
symptom
affecting
the
quality
of
life
in
patients
with
malignant
tumors.
For
those
refractory
pain,
palliative
sedation
combined
management
recommended.
Dexmedetomidine
(DEX),
known
for
its
unique
“awake
sedation”
effect,
remains
relatively
unexplored
when
used
conjunction
patient‐controlled
analgesia
(PCA)
terminal‐stage
cancer
patients.
This
study
aimed
to
assess
safety
and
efficacy
DEX
PCA
experiencing
pain.
Methods:
A
retrospective
analysis
was
conducted
on
who
received
hospice
ward
between
January
2020
June
2023.
Data
collection
included
general
patient
information,
laboratory
tests,
rating
scales,
conditions,
details,
sedative
effects,
changes
vital
signs
before
after
sedation.
Results:
Nine
at
doses
ranging
from
0.2
1.0
μ
g/kg·h
After
1
h
maximum
dose,
Richmond
Agitation‐Sedation
Scale
scores
significantly
decreased
(all
p
<
0.001).
While
heart
rate,
blood
oxygen
saturation,
respiratory
rate
remained
stable,
systolic
pressure
diastolic
were
lower
than
presedation
levels
(
=
0.040
0.044,
respectively).
Conclusion:
emerges
as
promising
option
When
PCA,
has
been
shown
effectively,
safely,
stably
control
without
inducing
adverse
effects
such
respiratory/circulatory
depression.
Annals of Palliative Medicine,
Journal Year:
2022,
Volume and Issue:
11(4), P. 1491 - 1504
Published: April 1, 2022
Background
and
Objective:
Dexmedetomidine
is
a
potent
adrenergic
alpha-2
receptor
agonist.
It
was
first
approved
for
sedation
mechanically
ventilated
patients.
Being
sedative
medication
that
not
associated
with
respiratory
depression
holding
analgesic
properties
fosters
the
interest
this
drug
in
palliative
care
field.
The
primary
objectives
of
review
were
to
identify
key
indications
real-world
use
dexmedetomidine
other
disciplines.
Methods:
A
narrative
after
extensive
PubMed
search
performed
from
1950
present
on
October
21st
2021.
language
publications
restricted
English,
German,
French
Italian.
Key
Content
Findings:
(I)
Current
use.
There
growing
body
evidence
may
reduce
incidence
severity
delirium,
opioid-consumption
postoperative
nausea
intensive
settings.
also
used
facilitate
withdrawal
different
substances
(alcohol,
opioids,
heroin).
Concerning
safety
aspects
drug,
some
studies
reported
an
increased
rate
serious
cardiovascular
events
patients
pre-existing
heart
conditions
due
bradycardia
arterial
hypo-
hypertension.
Since
has
main
hepatic
metabolism,
dose
reduction
mandatory
impairment.
(II)
care.
have
been
sporadic
case
reports
about
successful
Indications
symptom
control
included
hyperactive
cancer
pain,
opioid-induced-hyperalgesia,
dystonia,
cough,
vomiting,
shivering
dyspnea.
mainly
applied
via
intravenous
(i.v.),
subcutaneous,
but
nasal
and,
buccal
routes.
Admixture
("syringe-driver")
showed
compatible
morphine,
hydromorphone,
hyoscine
haloperidol.
In
2021,
prospective
cohort
study
became
available.
Here,
authors
promising
result
terminal
delirium
reducing
intensity
agitation.
Especially
unique
"conscious
sedation"
or
"awake
allows
arouse
easily
under
report
comfort
distress
discussed
by
authors.
Conclusions:
review,
we
findings
settings
potential
benefits
criticalities
are
practical
recommendations
its
provided.
Schweizerische medizinische Wochenschrift,
Journal Year:
2024,
Volume and Issue:
154(2), P. 3590 - 3590
Published: Feb. 15, 2024
Palliative
sedation
is
defined
as
the
monitored
use
of
medications
intended
to
induce
a
state
decreased
or
absent
awareness
(unconsciousness)
relieve
burden
otherwise
intractable
suffering
in
manner
ethically
acceptable
patient,
their
family,
and
healthcare
providers.
In
Switzerland,
prevalence
continuous
deep
until
death
increased
from
4.7%
2001
17.5%
all
deceased
2013,
depending
on
research
method
used
regional
variations.
Yet,
these
numbers
may
be
overestimated
due
lack
understanding
term
“continuous
sedation”
by
for
example
respondents
questionnaire-based
study.
Inadequately
trained
inexperienced
professionals
incorrectly
inappropriately
perform
palliative
uncertainties
regarding
its
definitions
practice.
Therefore,
expert
members
Bigorio
group
authors
this
manuscript
believe
that
national
recommendations
should
published
made
available
provide
practical,
terminological,
ethical
guidance.
The
working
Swiss
Care
Society
whose
task
publish
clinical
at
level
Switzerland.
These
aim
guidance
most
critical
questions
issues
related
sedation.
(palliative.ch)
mandated
writing
board
comprising
four
experts
(three
physicians
one
ethicist)
two
academic
revise
2005
guidelines.
A
first
draft
was
created
based
narrative
literature
review,
which
internally
reviewed
five
institutions
(Lausanne,
Geneva,
Bern,
Zürich,
Basel)
heads
groups
before
finalising
following
themes
are
discussed
sedation:
(a)
aspects,
(b)
decision-making
process,
(c)
communication
with
patients
families,
(d)
patient
monitoring,
(e)
pharmacological
approaches,
(f)
controversial
issues.
must
practised
accuracy
competence
avoid
harm
questionable
use.
Specialist
care
teams
consulted
initiating
overlooking
other
potential
treatment
options
patient’s
symptoms
suffering.
Pharmacology Research & Perspectives,
Journal Year:
2022,
Volume and Issue:
10(5)
Published: Sept. 13, 2022
α2-adrenoceptors,
(α2A,
α2B
and
α2C-subtypes),
are
Gi-coupled
receptors.
Central
activation
of
brain
α2A
α2C-adrenoceptors
is
the
main
site
for
α2-agonist
mediated
clinical
responses
in
hypertension,
ADHD,
muscle
spasm
ITU
management
sedation,
reduction
opiate
requirements,
nausea
delirium.
However,
despite
having
same
Gi-potency
functional
assays,
some
α2-agonists
also
stimulate
Gs-responses
whilst
others
do
not.
This
was
investigated.
Agonist
to
49
different
α-agonists
were
studied
(CRE-gene
transcription,
cAMP,
ERK1/2-phosphorylation
binding
affinity)
CHO
cells
stably
expressing
human
α2A,
or
α2C-adrenoceptor,
enabling
ligand
intrinsic
efficacy
be
determined
(binding
K
Cancer Management and Research,
Journal Year:
2023,
Volume and Issue:
Volume 15, P. 291 - 299
Published: March 1, 2023
Background:
Dyspnoea
affects
a
considerable
percentage
of
patients
with
terminal-stage
cancer,
and
clinical
guidelines
recommend
palliative
sedation
for
refractory
dyspnoea.
Midazolam
is
currently
the
most
commonly
used
sedative;
however,
it
can
cause
serious
adverse
reactions,
such
as
respiratory/circulatory
depression.
Hence,
there
need
an
alternative
sedative.
Dexmedetomidine
(DEX)
promising
its
"awake
sedation"
effect;
little
known
regarding
use
in
end-stage
Therefore,
aim
this
study
was
to
determine
safety
usefulness
DEX
Methods:
This
retrospective
included
cancer
who
received
owing
dyspnoea
hospice
ward
from
January
2018
October
2022.
We
analysed
their
general
data,
conditions,
details,
sedative
treatment
effect,
relief,
changes
vital
signs
before
after
sedation,
via
paired
t
-tests.
Results:
17
at
dose
0.2–
0.9
μg/kg·h
dyspnoea,
among
whom
6
(35%)
loading
1
μg/kg
10
min.
After
h
maximum
dose,
Respiratory
Distress
Observation
Scale
Richmond
Agitation-Sedation
scores
decreased
significantly
compared
those
(all
P
<
0.001),
did
respiratory
rate
(
=0.024
=0.008,
respectively).
The
heart
blood
oxygen
saturation
not
change,
whereas
systolic
diastolic
pressure
were
lower
than
(both
=0.015).
Conclusion:
safely
relieved
symptoms
without
inducing
reactions.
may
greatly
enhance
quality
life
cancer.
Keywords:
dexmedetomidine,
care,
Therapeutic Advances in Psychopharmacology,
Journal Year:
2023,
Volume and Issue:
13
Published: Jan. 1, 2023
Delirium
is
a
serious
consequence
of
many
acute
or
worsening
chronic
medical
conditions,
side
effect
medications,
and
precipitant
functional
cognitive
status
in
older
adults.
It
syndrome
characterized
by
fluctuations
cognition
impaired
attention
that
develops
over
short
period
time
response
to
an
underlying
condition,
substance
(prescribed,
the
counter,
recreational),
withdrawal
can
be
multi-factorial.
We
present
narrative
review
literature
on
nonpharmacologic
pharmacologic
approaches
prevention
treatment
delirium
with
focus
adults
as
vulnerable
population.
Older
adult
patients
are
most
at
risk
due
decreasing
physiologic
reserves,
rates
up
80%
critical
care
settings.
Presentation
hyperactive,
hypoactive,
mixed,
making
identification
study
challenging
hypoactive
less
likely
come
inpatient
long-term
setting.
Studies
nonpharmacological
medication
interventions,
preponderance
evidence
favoring
multi-component
effective.
Though
use
antipsychotic
common,
existing
does
not
support
routine
use,
showing
no
clear
benefit
clinically
significant
outcome
measures
harm
some
studies.
therefore
suggest
antipsychotics
used
treat
agitation,
psychosis,
distress
associated
lowest
effective
doses
shortest
possible
duration
considered
itself.
Future
studies
may
clarify
other
agents,
such
melatonin
receptor
agonists,
alpha-2
anti-epileptics.
Pain and Therapy,
Journal Year:
2023,
Volume and Issue:
12(2), P. 593 - 605
Published: Feb. 18, 2023
Dexmedetomidine,
an
alpha-2
adrenergic
receptor
agonist
with
potential
opioid
sparing
properties,
is
utilized
in
palliative
medicine,
but
the
knowledge
base
for
this
practice
limited.
We
describe
concomitant
use
of
dexmedetomidine
and
opioids
acute
care
unit.We
included
all
hospitalized
cancer
patients
treated
from
January
2019
to
2021.
Demographics,
doses,
indications
dosing,
reported
effects
adverse
responses,
as
well
treatment
lengths
were
recorded.Three
women
six
men
aged
42-66
years
metastatic
Eastern
Cooperative
Oncology
Group
(ECOG)
performance
status
I-IV
used
concomitantly.
Indications
pain
(n
=
7)
anxiety
2).
Dexmedetomidine
was
administered
intravenously
two
subcutaneously
seven.
All
administrations
continuous
infusions;
initial
doses
ranged
240
1344
µg/24
h
later
2440
h.
Physicians
relief
anxiety,
required
neuraxial
management
during
admission.
At
day
2
treatment,
dose
reduced
out
nine
patients.
For
available
data
at
7,
mean
74%
dose.
When
excluding
requiring
management,
corresponding
number
80%.
Two
had
transient
hypotension,
tolerated
no
cases
withdrawn
due
effects.
Mean
length
40
days.Dexmedetomidine
decreased
consumption
a
retrospective
study
It
may
represent
option
late
disease
trajectory.
