Baumgartner K, Groff V, Yaeger LH, et al. The use of dexmedetomidine in the emergency department: A systematic review. Acad Emerg Med. 2022 Nov 30. doi: 10.1111/acem.14636.
Abstract

BACKGROUND: Dexmedetomidine (DEX), a centrally acting alpha-2 agonist, is increasingly used for sedation in multiple clinical settings. Evidence from the intensive care unit and operative settings suggests DEX may have significant advantages over traditional GABAergic sedatives such as benzodiazepines. There has been limited research on the use of DEX in the emergency department (ED).

METHODS: We performed a systematic review of the medical literature to identify all published evidence regarding the use of DEX in the ED. We included randomized and nonrandomized studies and studies reporting any use of DEX in the ED, even when it was not the primary focus of the study. Two authors reviewed studies for inclusion, and a single author assessed studies for quality and risk of bias and abstracted data.

RESULTS: We identified 35 studies meeting inclusion criteria, including 11 randomized controlled trials, 13 cohort and other nonrandomized studies, and 11 case reports and case series. Significant heterogeneity in interventions, comparators, indications, and outcomes precluded data pooling and meta-analysis. We found modest evidence that DEX was efficacious in facilitating medical imaging and mixed and limited evidence regarding its efficacy for procedural sedation and sedation of nonintubated medical and psychiatric patients. Our results suggested that DEX is associated with bradycardia and hypotension, which are generally transient and infrequently require medical intervention.

CONCLUSIONS: A limited body of generally poor- to moderate-quality evidence suggests that the use of DEX may be efficacious in certain clinical scenarios in the ED and that DEX use in the ED is likely safe. Further high-quality research into DEX use in the ED setting is needed, with a particular focus on clear and consistent selection of indications, identification of clear and clinically relevant primary outcomes, and careful assessment of the clinical implications of the hemodynamic effects of DEX therapy.

Ratings by Clinicians (at least 3 per Specialty)
Specialty Score
Pediatric Emergency Medicine
Emergency Medicine
Anesthesiology
Comments from MORE raters

Pediatric Emergency Medicine rater

Dexmedetomidine is increasingly used in the emergency department to provide sedation. This systematic review identified published evidence about using dexmedetomidine (DEX) in the emergency department. Evidence is limited and a conclusion is difficult to draw as there is significant heterogeneity in the evidence. There are also concerns about the methodology of the included studies. Further research is necessary to carefully define and investigate the indications for DEX.