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Management of severe delirium with dexmedetomidine in a palliative care patient—a case report

  • Andrej Hostnik1
  • Teodora Zupanc2
  • Iztok Potočnik2,3,*,

1Clinical department of anaesthesiology and surgical intensive therapy, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia

2Department of anaesthesiology and perioperative intensive therapy, Operative sector, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia

3Department of anaesthesiology and reanimatology, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia

DOI: 10.22514/sv.2024.011 Vol.20,Issue 1,January 2024 pp.145-149

Submitted: 16 November 2022 Accepted: 07 March 2023

Published: 08 January 2024

*Corresponding Author(s): Iztok Potočnik E-mail: ipotocnik@onko-i.si

Abstract

Dexmedetomidine is used as an adjunct to anaesthesia or as a stand-alone agent for conscious sedation. It is a potent α2-adrenergic receptor agonist, with a fast onset of action and peak effects in 30 minutes to 1 hour after application, depending on the route of administration. It is metabolized in the liver and excreted in urine as a glucuronide. It potentiates analgesia and is effective in opioid sparing. Clinical trials show its efficacy in the treatment of Intensive Care Unit (ICU) delirium with an effect comparable to antipsychotics and benzodiazepines. It has also been used at the Eye Clinic of the University Medical Centre Ljubljana to sedate patients undergoing intraocular surgery. It proved to be an excellent alternative to other sedatives and analgesics, such as midazolam and remifentanil. The aim of this paper is to review the pharmacokinetics and pharmacodynamics of dexmedetomidine and to investigate its potential use in the palliative care population, particularly in the management of delirium. This area of application is still largely unexplored and opens up a new field of application. At the Institute of Oncology (IO) Ljubljana, we have used it with success in several palliative patients with delirium, when all other modalities were failing. At the IO Ljubljana, anaesthesiologists are involved in the palliative management of patients, especially in pain management, but also in sedation and delirium treatment. Given its favourable pharmacokinetic and pharmacodynamic effects, dexmedetomidine could be used more frequently and perhaps alternative and less complex routes of administration, such as intranasal administration, could be explored. In this paper, we present a case of a palliative care patient in whom dexmedetomidine was used successfully.


Keywords

Sedation; Delirium; Palliative care; Dying patient


Cite and Share

Andrej Hostnik,Teodora Zupanc,Iztok Potočnik. Management of severe delirium with dexmedetomidine in a palliative care patient—a case report. Signa Vitae. 2024. 20(1);145-149.

References

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