In this episode, I’ll discuss an article about clinical outcomes when dexmedetomidine is given to patients who have agitation from drug overdose or withdrawal.
Dexmedetomidine fills a crucial role in the management of agitated patients given that it usually provides sedation without interfering with respiratory function. It is frequently used for this purpose despite an absence of an official FDA indication. A group of authors recently published a retrospective cohort study based on a chart review of electronic records from the Virginia Poison Control Center to describe clinical outcomes after dexmedetomidine was given to patients who presented to the ED with an overdose and needed management of agitation.
The authors found 70 cases of agitated overdose patients who received dexmedetomidine and satisfied their inclusion/exclusion criteria out of a possible 220 cases in the database.
27% of the patients in the cohort had overdose from an antimuscarinic, 23% had polysubstance ingestion, 14% had withdrawal from a sedative, 14% had either an unknown reason for agitation or an unknown cause of overdose, and smaller numbers of patients had overdose from a sympathomimetic, antipsychotic, hallucinogenic agent, sedative/hypnotic, or withdrawal from another agent like baclofen or opioids.
When dexmedetomidine was initiated, 89% of the patients in the cohort experienced clinical improvement.
Two patients had to be intubated after starting dexmedetomidine due to refractory agitation, and two more needed to be intubated due to hypoxia after aspirating with oversedation being the reason in one of these patients.
This study highlights that in general, when a patient with agitation from drug overdose or withdrawal is started on dexmedetomidine, clinical improvement is seen in almost every case. However, monitoring is essential because dexmedetomidine is not universally effective at controlling agitation and even though dexmedetomidine does not suppress the respiratory drive, it may cause sedation to a point where patients may not be able to protect their airway in the event of aspiration.
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