Dexmedetomidine: Unravelling its multiple roles in clinical practice

Abstract

Background: Dexmedetomidine (Dex) is an alpha-2 adrenergic agonist that has increasing attention in clinical practice due to its role in sedation, analgesia, and hemodynamic regulation. Initially introduced as a sedative for critically ill patients, its uses have expanded to various perioperative and critical care settings. Aim: This article aimed to examine the pharmacological properties, clinical applications, and evolving roles of dexmedetomidine. Method: A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “anaesthesia”, “analgesia”, “anti-“inflammatory” effect and “pharmacological effect”. Results: Dexmedetomidine has valuable effect in a variety of clinical settings. Its unique sedative response, analgesic, antioxidant, anti-inflammatory, and sympatholytic effects make it an excellent choice for sedation in critically ill patients, as well as an adjunct to anesthesia in the perioperative setting. The sympatholytic effect of dexmedetomidine also provide stable hemodynamics during the perioperative period. The emerging evidence of its neuroprotective properties further expands its potential applications, particularly in reducing postoperative delirium and improving cognitive outcomes in elderly patients. While generally safe, its use requires careful monitoring, especially in patients with cardiovascular comorbidities. Conclusion: as the clinical understanding of dexmedetomidine continues to evolve, its role in both critical care and perioperative medicine is expected to expand, offering a safer and more effective alternative to traditional sedatives and analgesics. Although, the extended applications of dexmedetomidine discussed in this review are promising, it still limited, and further research is required. The pharmacological properties and possible adverse effects of dexmedetomidine should be well understood by the anesthesiologist prior to use.