Wednesday, November 05, 2014

Dexmedetomidine as an adjunct for alcohol withdrawal: non-evidence based but promising

Dexmedetomidine for treatment of alcohol withdrawal has appealing properties but is off label and one of the most non-evidence based practices in intensive care medicine. But this small study is promising:

Materials and Methods
This retrospective case series evaluated 33 critically ill adults with a primary diagnosis of AWS from 2006 to 2012 at an academic medical center.

Dexmedetomidine began a median (interquartile range) of 11 (2, 32) hours into intensive care unit admission and was titrated to an infusion rate of 0.7 (0.4, 0.7) μg kg−1 h−1 to achieve the desired depth of sedation. In the 12 hours after dexmedetomidine began, patients experienced a 20-mg reduction in median cumulative benzodiazepine dose used (P less than .001), a 14-mm Hg lower mean arterial pressure (P = .03), and a 17-beats/min reduction in median heart rate (P less than .001). Four (12%) patients experienced hypotension (systolic blood pressure less than 80 mm Hg) during therapy, and there were no cases of bradycardia (heart rate less than 40 beats/min).

Dexmedetomidine decreased benzodiazepine requirements and improved the overall hemodynamic profile of patients with severe AWS. These results provide promising evidence about the potential benefit of dexmedetomidine for AWS.

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