Immunomodulatory effects of dexmedetomidine: From bench to clinic

Dexmedetomidine is a central alpha2-adrenergic receptor agonist with sedative and analgesic properties that has a proven safety profile. It has several beneficial effects such as decreasing sympathetic tone, leading to reduced opiate use and anxiolysis, making it an attractive option for sedation in the perioperative and intensive care unit setting. These effects also modify favorably the time spent on a ventilator, intensive care unit length of stay and development of delirium. Recent studies also suggest that dexmedetomidine possesses wide-ranging immunomodulating properties. It has been associated with reduced inflammatory cytokine release, modulation of inflammatory transcription fac tors, oxidative stress and inflammatory cells. These properties could be beneficial in the context of inflam matory conditions that require sedation, such as sepsis, ischemia-reperfusion injury and ventilator-associated lung injury, among many others. In this review, we propose specific clinical scenarios where these properties could turn out to be clinically relevant.