EFFECTS OF INTRAVENOUS DEXMEDETOMIDINE IN HUMANS .1. SEDATION, VENTILATION, AND METABOLIC-RATE

Dexmedetomidine (DMED) is a highly selective centrally acting alpha2-adrenergic agonist thought to provide significant sedation without appreciable ventilatory effects. This double-blind, placebo-controlled experiment evaluated four dose levels of DMED (0.25, 0.5, 1.0, and 2.0 mug/kg intravenously over 2 min) in 37 healthy male volunteers. Measurements of sedation, arterial blood gases, resting ventilation, hypercapnic ventilatory response (HVR), and metabolic rate (O2 consumption and CO2 production) were performed at baseline, 10 min after DMED infusion, and thereafter at the end of each subsequent 45-min period. DMED caused sedation resulting in loss of responsiveness in most of the subjects administered 1.0 and 2.0 mug/kg; sedation was evident for 195 min following 2.0 mug/kg (P < .05). Ten minutes following infusion of 1.0 and 2.0 mug/kg, Pa(CO2) had increased by 5.0 and 4.2 mmHg, respectively (P < .05), and 60 min following 2.0 mug/kg, V(E) had decreased by 28% (P < .05). The placebo group showed a progressive increase in the HVR stope (50% increase by 330 min following the infusion; P < .05). Overall, across all the DMED doses, the slope was decreased (P < .05) at all times after DMED. The calculated ventilation at a Pa(CO2) of 55 mmHg was decreased (39%; P < .05) 10 min following 1.0 and 2.0 mug/kg, returning to control values by 285 min following 2.0 mug/kg. O2 consumption increased 16% (P < .05) at 10 min following 2.0 mug/kg; CO2 production decreased (22% at 60 min). By 5 h postinfusion, both had returned to normal. Intravenous DMED caused sedation and sleep with minor decreases in resting ventilation, whereas the HVR was reduced slightly. The increase in oxygen consumption seen immediately after administration of DMED is not readily explained by the known physiologic effects of alpha2-adrenergic agonists.