Precedex

TennRN2004 · Apr 5, 2006

Anyone using Precedex with their CABs? What is your experience? I think I like it so far....

LOVE IT LOVE IT !! And the pts do too. It is an excellent drug for the CABs you want to wake up and get extubated quickly. It also cuts down on the dose of pain meds you have to give, and is helpful for the patients who tend to be anxious and take prn ativan at home. I think it is perfect for CAB patients.

toadie · Apr 8, 2006

i've had patients on this and its great. it can only hang for a certain time though, i think 24 hours.

my2sons · Apr 9, 2006

Right. 24 hours is the maximum. I hit a snag with it though. The bag that the MDA hung in the OR was about to run dry and our pharmacy would not mix or release another bag to me. Their policy will only allow CRNAs or MDAs to receive /hang Precedex. Hmmm, got to figure this out.

TennRN2004 · Apr 9, 2006

i've had patients on this and its great. it can only hang for a certain time though, i think 24 hours.

Currenty, the max dose is also only 0.7 mcg/kg/hr, but there are ongoing studies to demonstrate the safety of higher doses and longer hang times. The company used the current approved dose and hang time of 24 hours so they could get the drug on the market as fast as possible. We've had vent patients on it for 2 or 3 days, it's just not the manufactered recommendation to go over 24 hours. Diprivan is the same way, but it's been around longer, so I think people are more comfortable with it for that reason.

RoxanRN · Apr 9, 2006

Right. 24 hours is the maximum.

hhmmmm.... I know we certainly run it for longer than 24 hours........

TennRN2004 · Apr 9, 2006

Right. 24 hours is the maximum. I hit a snag with it though. The bag that the MDA hung in the OR was about to run dry and our pharmacy would not mix or release another bag to me. Their policy will only allow CRNAs or MDAs to receive /hang Precedex. Hmmm, got to figure this out.

I don't understand this either. Precedex has many indications, not just the OR. It can be used without an established airway (Bipap, venti) for pts who need sedation. Precedex is also used at some facilities for overdose patients. It makes no sense to me why only anesthesia providers are allowed to hang it. I would check into this-- is it a pharmacy policy or a hospital policy? Either one still doesnt make sense, but I would think maybe if the pharmacy was educated and there was no hospital policy against it, you'd have a better change of changing any such policy.

The only thing that differs at my hospital between the ICU and the OR/anesthesia staff in regards to precedex is bolusing it. We never bolus precedex in the unit, but anethesia does/can if they need to.

huadring · Apr 14, 2006

We practically only use Dex for our CT surgery patients. Although I have seen some pts get a little hypotensive it usually doesn't happen. They are awakable but subdued. It is a great alternative. We've definitely had some patients on it for weeks, and a few larger people at doses up to 1 mcg/kg/h. A lot of times the nurses will suggest it to the CCU residents who usually have never heard of it.

rvcvicu · Jul 3, 2011

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.

beachbumRN88 · Oct 1, 2011

I am a new nurse. We hang precedex gtts often. Usually not pass 0.7mcg but recently we have had docs write to titrate up to 2 mcg. The manufacturing recommends not doing this.

Anyone know the legal side of this? With a docs orders are we covered?