Dexmedetomidina en la práctica de anestesia: ¿Una droga maravillosa?

Dexmedetomidina en la práctica de anestesia: ¿Una droga maravillosa? Dexmedetomidine in anaesthesia practice: A wonder drug?. Sudheesh K, Harsoor SS. Indian J Anaesth 2011;55:323-4 Dexmedetomidine has become of the frequently used drugs in anaesthetic armamentarium, along with routine anaesthetic drugs, due to its haemodynamic, sedative, anxiolytic, analgesic, neuroprotective and anaesthetic sparing effects. Other claimed advantages include minimal respiratory depression with cardioprotection, neuroprotection and renoprotection, thus making it useful at various situations including offsite procedures. α-1 to α-2 ratio of 1:1600 makes it a highly selective α-2 agonist compared to clonidine, thus reducing the unwanted side effects involving α-1 receptors. High selectivity of dexmedetomidine to α-2A receptors (which mediate analgesia and sedation) has been exploited by various authors in regional anaesthesia practice. http://www.ijaweb.org/temp/IndianJAnaesth554323-4304549_115725.pdf  Dexmedetomidina y clonidina en anestesia epidural: una evaluación comparativa   Dexmedetomidine and clonidine in epidural anaesthesia: A comparative evaluation. Bajwa SJ, Bajwa SK, Kaur J, Singh G, Arora V, Gupta S, Kulshrestha A, Singh A, Parmar SS, Singh A, Goraya S. Indian J Anaesth 2011;55:116-21 Efforts to find a better adjuvant in regional anaesthesia are underway since long. Aims and objectives are to compare the efficacy and clinical profile of two α-2 adrenergic agonists, dexmedetomidine and clonidine, in epidural anaesthesia with special emphasis on their sedative properties and an ability to provide smooth intra-operative and post-operative analgesia. A prospective randomized study was carried out which included 50 adult female patients between the ages of 44 and 65 years of (American Society of Anaesthesiologists) ASAI/II grade who underwent vaginal hysterectomies. The patients were randomly allocated into two groups; ropivacaine + dexmedetomidine (RD) and ropivacaine + clonidine (RC), comprising of 25 patients each. Group RD was administered 17 ml of 0.75% epidural ropivacaine and 1.5 μg/kg of dexmedetomidine, while group RC received admixture of 17 ml of 0.75% ropivacaine and 2 μg/kg of clonidine. Onset of analgesia, sensory and motor block levels, sedation, duration of analgesia and side effects were observed. The data obtained was subjected to statistical computation with analysis of variance and chi-square test using statistical package for social science (SPSS) version 10.0 for windows and value of P< 0.05 was considered significant and P< 0.0001 as highly significant. The demographic profile, initial and post-operative block characteristics and cardio-respiratory parameters were comparable and statistically non-significant in both the groups. However, sedation scores with dexmedetomidine were better than clonidine and turned out to be statistically significant (P< 0.05). The side effect profile was also comparable with a little higher incidence of nausea and dry mouth in both the groups which was again a non-significant entity (P> 0.05). Dexmedetomidine is a better neuraxial adjuvant compared to clonidine for providing early onset of sensory analgesia, adequate sedation and a prolonged post-operative analgesia. http://www.ijaweb.org/temp/IndianJAnaesth554340-571157_155155.pdf

Atentamente Dr. José Reyes Guzmán Anestesiología y Medicina del Dolor www.anestesia-dolor.org