GasGasGas - The FRCA Primary Exam Podcast GasGasGas - Dexmedetomidine
Sep 26, 2025
Discover the fascinating world of dexmedetomidine, a newly embraced sedative in the UK. Unravel its unique alpha-2 agonism and how it creates sleep-like sedation. Learn about its clinical applications, including its use in awake craniotomies and pediatric sedation. The discussion covers its side effects, like cardiovascular impacts and minimal respiratory depression. Plus, insights into its pharmacokinetics reveal important information about dosing and metabolism. Perfect for anyone looking to deepen their knowledge in anaesthetics!
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High Alpha‑2 Selectivity Explains Its Effects
- Dexmedetomidine is a highly selective alpha-2 agonist producing sedation, anxiolysis and some analgesia.
- It is ~1,620:1 selective for alpha-2 vs alpha-1 and about eight times more alpha-2 selective than clonidine.
Sedation Mimics Natural Sleep
- Key sites of action include the locus coeruleus and ventrolateral preoptic nucleus within the reticular activating system.
- This produces a sleep‑like, easily rousable sedation distinct from general anaesthesia.
Sleep Type Might Affect Brain Clearance
- Stage 3 (deep non‑REM) sleep may facilitate glymphatic CSF clearance; typical sedatives might not replicate this restorative state.
- Dr Gas Lurks hypothesises ICU patients sedated with propofol miss 'tidying' sleep, possibly contributing to delirium.