Dexmedetomidine and Propofol have very different mechanisms of action and pharmacokinetic profiles that make them attractive sedative agents.
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
- Premedication – patients susceptible to preoperative and perioperative stress because of its sedative, anxiolytic, analgesic, sympatholytic, and stable hemodynamic profile.
- Intraoperative use
- Locoregional analgesia: Dexmedetomidine though enhances both central and peripheral neural blockade by local anesthetics;
- 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.
- Procedural sedation: Short-term procedural sedation and has been safely used in transesophageal echocardiography, colonoscopy, etc.
- Controlled hypotension mediated by its central and peripheral sympatholytic action.
- Other indications: Neurosurgery, Cardiac surgery, Obesity, Paediatrics
- 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.
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.
- ICU for long-term (sometimes weeks) sedation.
- Induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients >2 months of age;
- In adults, for monitored anesthesia care sedation during procedures; sedation in intubated, mechanically-ventilated ICU patients, postoperative antiemetic; etc.
- Geriatric -General anesthesia.
- Renal and Hepatic impairment: No dosage adjustment necessary