I work in a large regional medical center, and have utilized precedex daily for over seven years. This is an excellent drug for sedation, anxiety mitigation, and as an adjunct pain controller. Our population is primarily post open heart patients (cabg, valves, VSD, maze). Typically, the patients exit the OR on precedex alone or in conjunction with diprivan. As we wean toward extubation, diprivan is dc'd, and precedex continued. Titration is usually from 0.3mkm to 0.7mkm. With orders, titration up to 1.3mkm has been used while maintaining SBP greater than 90 and HR greater than 80.
Compared to diprivan, precedex takes longer to reach therapeutic effect, and will not "shut down," an at risk for injury patient. To be certain, non compliant, confused patients, at risk of self extubation or injury, receive "mother's milk." Experience demonstrates that most patients become compliant with the extubation procedure by the second or third awakening from diprivan. Once compliant, the diprivan is stopped, and precedex continued.
Precedex calms the patient without depressing the respiratory effort, hence you may continue precedex sedation through extubation, something not recommended with diprivan. Precedex also has synergistic effects with IV morphine and dilauded, thus enhancing the latter drugs' pain control.
Like all drugs, effects may vary from patient to patient. 98% of my patients benefit. About 2% display resistance.
Note that although rare, I have experienced rapid bradycardic and hypotensive episodes requiring immediate cessation of precedex, with some combination of pacing, fluid volume resuscitation and levophed.
All drugs carry some risk of negative outcome. That's why experienced nurses are valuable.