201: DEXMEDETOMIDINE FOR END-OF-LIFE SYMPTOM MANAGEMENT: A SYSTEMATIC REVIEW

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Pharmacological treatments, Treatment/management , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Patients at the end of life frequently experience distressing symptoms such as pain, agitation, anxiety, dyspnea, and delirium that may persist despite standard palliative therapies, including opioids and benzodiazepines. These conventional agents are also associated with adverse effects such as excessive sedation, respiratory depression, and paradoxical agitation. Dexmedetomidine, a selective alpha-2 adrenergic agonist with sedative, anxiolytic, and analgesic properties, provides arousable sedation with minimal respiratory suppression, making it a potential option for refractory symptoms in end-of-life care. However, evidence supporting its use in this setting remains limited and largely observational.

Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, the Cochrane Library, and Google Scholar. Eligible studies included English-language reports involving adult patients receiving end-of-life or palliative care who were administered dexmedetomidine for symptom control. Following PRISMA guidelines, titles and abstracts were screened, full texts were assessed for eligibility, and data were extracted using a standardized form. Methodological quality was appraised using appropriate Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in study design, interventions, and outcome measures, findings were synthesized narratively without meta-analysis.

Results: Out of 214 records identified, seven observational studies met the inclusion criteria and were included in the final qualitative synthesis. The included studies consisted of retrospective cohort studies and case series conducted across hospice, palliative care units, and hospital-based settings. Dexmedetomidine was primarily used for refractory pain, dyspnea, agitation, delirium, and terminal restlessness. Across studies, dexmedetomidine was associated with improved symptom control, enhanced patient comfort, and preservation of respiratory drive. Hemodynamic adverse effects such as hypotension and bradycardia were reported but were generally mild, transient, and manageable, with no serious or unexpected adverse events directly attributed to dexmedetomidine.

Conclusions: Current observational evidence suggests that dexmedetomidine may be a useful adjunctive agent for managing refractory symptoms in end-of-life care, particularly when conventional palliative medications are ineffective or poorly tolerated. While the certainty of evidence is limited by non-randomized study designs and small sample sizes, the consistency of findings across diverse clinical settings supports cautious consideration of dexmedetomidine within individualized, comfort-focused palliative care strategies. Further prospective and methodologically robust studies are needed to better define its role in end-of-life symptom management.

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Presenting Author: Christoph Anton T. Habaluyas
Submitting Author: Christoph Anton Habaluyas

Senior Author: Christoph Anton T. Habaluyas

IASP 2026 Global Year theme of Neuropathic Pain: No

• Lyde A. Magpantay: MD, MSc - St. Luke's Medical Center - Quezon City