Target trial emulation on dexmedetomidine for critically ill patients: all that glitters is not gold - Critical Care Science (CCS)
Critical Care Science. 06-04-2025;37:e20250118
Alpha-2 agonists have been used as anesthetic adjuncts for a very long time. Initially, drugs such as xylazine and detomidine were almost solely used for veterinary practice. Subsequent studies demonstrated the effectiveness of deep anesthesia in animals employing the newer, more potent, and selective alpha-2-agonists, such as the stereoisomer of medetomidine, dexmedetomidine (D-isomer).
In the 1990s, alpha-2 agonists became increasingly present in human anesthesiologists’ drug arsenal, with clonidine as the primary agent. Dexmedetomidine was soon included among the options for anesthesia and intensive care unit (ICU) use for postoperative patients (short-term use, i.e., < 24 hours). For mechanically ventilated patients who require prolonged sedation and agitation control, dexmedetomidine was still not considered an option until the early 2000s,() with midazolam and propofol being considered preferred sedatives due to their more predictable awakening and titration. “The role of this new agent in sedation of ICU patients”, according to guidelines at the time, remained “to be determined”.
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Alpha-2 agonists have been used as anesthetic adjuncts for a very long time. Initially, drugs such as xylazine and detomidine were almost solely used for veterinary practice. Subsequent studies demonstrated the effectiveness of deep anesthesia in animals employing the newer, more potent, and selective alpha-2-agonists, such as the stereoisomer of medetomidine, dexmedetomidine (D-isomer).
In the 1990s, alpha-2 agonists became increasingly present in human anesthesiologists’ drug arsenal, with clonidine as the primary agent. Dexmedetomidine was soon included among the options for anesthesia and intensive care unit (ICU) use for postoperative patients (short-term use, i.e., < 24 hours). For mechanically ventilated patients who require prolonged sedation and agitation control, dexmedetomidine was still not considered an option until the early 2000s,() with midazolam and propofol being considered preferred sedatives due to their more predictable awakening and titration. "The role of this new agent in sedation of ICU patients", according to guidelines at the time, remained "to be determined".
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