Dexmedetomidine is a promising alternative sedative agent for moderate-severe Traumatic brain injury (TBI) patients. Although the data are limited, the posited benefits of dexmedetomidine in this population are a reduction in secondary brain injury compared with current standard sedative regimens. In this scoping review, we critically appraised the literature to examine the effects of dexmedetomidine in patients with moderate-severe TBI to examine the safety, efficacy, and cerebral and systemic physiological outcomes within this population. We sought to identify gaps in the literature and generate directions for future research. Two researchers and a librarian queried PubMed, Embase, Scopus, and APA PsycINFO databases. Of 920 studies imported for screening, 11 were identified for inclusion in the review. The primary outcomes in the included studied were cerebral physiology, systemic hemodynamics, sedation levels and delirium, and the presence of paroxysmal sympathetic hyperactivity. Dexmedetomidine dosing ranged from 0.2 to 1 ug/kg/h, with 3 studies using initial boluses of 0.8 to 1.0 ug/kg over 10 minutes. Dexmedetomidine used independently or as an adjunct seems to exhibit a similar hemodynamic safety profile compared with standard sedation regimens, albeit with transient episodes of bradycardia and hypotension, decrease episodes of agitation and may serve to alleviate symptoms of sympathetic hyperactivity. This scoping review suggests that dexmedetomidine is a safe and efficacious sedation strategy in patients with TBI. Given its rapid onset of action and anxiolytic properties, dexmedetomidine may serve as a feasible sedative for TBI patients.

中文翻译：

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右美托咪定用于创伤性脑损伤镇静的安全性、有效性和临床结果：范围界定综述。

右美托咪定是一种有前途的替代镇静剂，适用于中重度创伤性脑损伤 (TBI) 患者。尽管数据有限，但与当前标准镇静方案相比，右美托咪定在该人群中的预期益处是减少继发性脑损伤。在本次范围审查中，我们严格评估了右美托咪定对中重度 TBI 患者的影响的文献，以检查该人群的安全性、有效性以及脑部和全身生理结果。我们试图找出文献中的空白并为未来的研究确定方向。两名研究人员和一名图书馆员查询了 PubMed、Embase、Scopus 和 APA PsycINFO 数据库。在导入进行筛选的 920 项研究中，确定了 11 项纳入审查。纳入研究的主要结果是脑生理学、全身血流动力学、镇静水平和谵妄，以及阵发性交感神经过度活跃的存在。右美托咪定剂量范围为 0.2 至 1 ug/kg/h，其中 3 项研究使用 10 分钟内初始推注剂量为 0.8 至 1.0 ug/kg。单独使用或作为辅助药物使用右美托咪定似乎表现出与标准镇静方案相似的血流动力学安全性，尽管会出现短暂的心动过缓和低血压发作，但可以减少躁动发作，并可能有助于缓解交感神经过度活跃的症状。本次范围审查表明，右美托咪定对于 TBI 患者来说是一种安全有效的镇静策略。鉴于其快速起效和抗焦虑特性，右美托咪定可作为 TBI 患者的可行镇静剂。