Dexmedetomidine pharmacodynamics in healthy volunteers: 2. Haemodynamic profile

• Published in: British journal of anaesthesia : BJA Vol. 119; no. 2; pp. 211 - 220
• Main Authors: Colin, P.J., Hannivoort, L.N., Eleveld, D.J., Reyntjens, K.M.E.M., Absalom, A.R., Vereecke, H.E.M., Struys, M.M.R.F.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-08-2017; Oxford University Press
• Subjects: Adolescent; Adult; Aged; Arterial Pressure - drug effects; dexmedetomidine; Dexmedetomidine - pharmacology; Female; haemodynamics; healthy volunteers; Heart Rate - drug effects; Hemodynamics - drug effects; Humans; hypnotics and sedatives; Hypnotics and Sedatives - pharmacology; Male; Middle Aged; Models, Biological; pharmacology; Young Adult; dexmedetomidine; hypnotics and sedatives; haemodynamics; healthy volunteers; pharmacology
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aex086

Dexmedetomidine, a selective α2-adrenoreceptor agonist, has unique characteristics, with little respiratory depression and rousability during sedations. We characterized the haemodynamic properties of dexmedetomidine by developing a pharmacokinetic–pharmacodynamic (PKPD) model with a focus on changes in mean arterial blood pressure (MAP) and heart rate.
Dexmedetomidine was delivered i.v. to 18 healthy volunteers in a step-up fashion by target-controlled infusion using the Dyck model. Exploratory PKPD modelling and covariate analysis were conducted in NONMEM.
Our model adequately describes dexmedetomidine-induced hypotension, hypertension, and bradycardia, with a greater effective concentration for the hypertensive effect. Changes in MAP were best described by a double-sigmoidal Emax model with hysteresis. Covariate analysis revealed no significant covariates apart from age on the baseline MAP in the population pharmacokinetic model used to develop this PKPD model. Simulations revealed good general agreement with published descriptive studies of haemodynamics after dexmedetomedine infusion.
The present integrated PKPD model should allow tighter control over the desired level of sedation, while limiting potential haemodynamic side-effects.
NCT01879865.