Sedation in Traumatic Brain Injury

Table 8

Dexmedetomidine
Group	Selective α2 adrenergic agonist
Mechanism of Action/Pharmacodynamics	Peripheral α2A, brain & spinal cord α2B, α2C adrenoreceptor subtypes
Neuroprotective effects	Reduces CBF and ICP
Pharmacokinetics	Hepatic metabolism; Distribution 𝑡1/2 6 minutes; Elimination 𝑡1/2 2 hours
Advantages	Minimal respiratory depression; Reduction in delerium
Disadvantages and major side effects	Hypotension (28%); Bradycardia; Arrhythmias including atrial fibrillation; Relatively high cost
Dosage	Loading dose: 1 mcg/kg; Infusion: 0.42–1.0 mcg/kg/hour
Other significant facts	Minimal effect on respiratory function
Appropriate uses in TBI	Maintenance sedation agent pre & post extubation; Management of agitated delirium