An Updated Focused Review of Dexmedetomidine in Adults

sies about optimal indication and dosage have persisted.1 Dexmedetomidine is an α2-receptor agonist that produces sedation and analgesia without causing respiratory depression. It is unique among commonly used sedatives in the intensive care unit (ICU) because its mechanism is not medi-ated by the γ-aminobutyric acid (GABA) system.1 Since our last review of dexmed-etomidine, in 2007, more data have been published and dexmedetomidine has re-ceived approval for a new indication in the US, namely sedation of nonintubated pa-tients prior to and/or during surgical and other procedures.1,2 Ongoing issues re-garding its use for procedural sedation, maximum dose, and use longer than 24 hours have been at least partially an-swered. Although several trials have stud-ied dexmedetomidine in the prevention and treatment of delirium, results from only one small randomized controlled trial with delirium as a primary outcome have been published, and more data are needed to define its role in the delirious patient. Data from the Project IMPACT database of almost 110,000 patients be