Dexmedetomidine in Anaesthesia: Pharmacological Mechanisms and Expanding Clinical roles

Abstract

Anesthetic practice has traditionally relied on GABAergic agents, which induce deep unconsciousness but often impair breathing and delay cognitive recovery. Dexmedetomidine offers an alternative by targeting alpha-2 adrenergic receptors in the Locus Coeruleus, producing a biomimetic, sleep-like state that preserves cooperation and reduces the need for opioids and volatile anesthetics, thereby lowering postoperative nausea and delirium. Recent research highlights its organ-protective effects, showing it can shield the brain, heart, and kidneys from ischemia-reperfusion injury through molecular mechanisms such as regulating autophagy and inhibiting the NLRP3 inflammasome. However, its sympatholytic action can cause bradycardia and hypotension, so its use is best tailored to high-risk cases where organ protection outweighs cardiovascular risks.