Dexmedetomidine and Propofol

Dexmedetomidine and Propofol have very different mechanisms of action and pharmacokinetic profiles that make them attractive sedative agents.

Dexmedetomidine

Dexmedetomidine is a centrally acting, alpha-2 adrenergic receptor agonist approved by FDA for sedation in mechanically ventilated patients during the first 24 hours and in non-intubated patients prior to and/or during surgical or nonsurgical procedures.

Indications and Uses of Dexmedetomidine and Propofol

  1. Premedication – patients susceptible to preoperative and perioperative stress because of its sedative, anxiolytic, analgesic, sympatholytic, and stable hemodynamic profile.
  2. Intraoperative use
  3. Locoregional analgesia: Dexmedetomidine though enhances both central and peripheral neural blockade by local anesthetics;
  4. Sedation in the intensive care unit- Dexmedetomidine has become a popular sedative agent in ICU because of its ability to produce cooperative sedation, i.e., patients remain awake, calm, and are able to communicate their needs.
  5. Procedural sedation: Short-term procedural sedation and has been safely used in transesophageal echocardiography, colonoscopy, etc.
  6. Controlled hypotension mediated by its central and peripheral sympatholytic action.
  7. Analgesia
  8. Other indications: Neurosurgery, Cardiac surgery, Obesity, Paediatrics
  9. Miscellaneous:
  • Withdrawal from benzodiazepines, opioids, alcohol, and recreational drugs.
  • As an adjunct in otorhinolaryngology anesthesia.
  • As an adjunct in the repair of aortic aneurysms.
  • Management of tetanus in ICU.
  • As an anti-shivering agent.
  • Preventing ethanol-induced neurodegeneration.

Dexmedetomidine

Propofol (Milk of amnesia)

A sedative-hypnotic agent used in the induction or maintenance of anesthesia or sedation. It has a rapid onset, short duration of action, and relatively low cost.

  1. ICU for long-term (sometimes weeks) sedation.
  2. Induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients >2 months of age;
  3. In adults, for monitored anesthesia care sedation during procedures; sedation in intubated, mechanically-ventilated ICU patients, postoperative antiemetic; etc.
  4. Geriatric -General anesthesia.
  5. Renal and Hepatic impairment: No dosage adjustment necessary

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