Originally Posted by mjl2525

What have been your experiences with this medication. How do you compare it to the use of propofol? Better/worse??? We are being trained on it; as our physicians have started to use it more frequently. Any advice, experience in the use of it, etc. would be greatly appreciated!!!!!!!!!!!!!!!!!!

Our cardiac surgeons use Precedex on our post op hearts when we are weaning them for extubation in the first few hours after surgery. The main problem I've had with it is hypotension esp. in more elderly patients. It certaintly creates a controlled sedation and still allows the patient to begin to awaken from the sedation and anesthesia from their surgery. I've had patients on CPAP for as long as 1.5 hours with no problems. The usual dose is 0.5mcg/kg/hr. We initially would bolus the patient with 1mcg/kg/hr for 10 minutes but we have found that really isn't necessary. I usu. start to titrate the dosage down as the patient begins to awaken more and as long as I have controlled sedation for the patient. I've actually extubated patients while on Precedex with no problems.

Response to Begalli

Originally Posted by begalli

Also, as far as the use of this drug decreasing the need for pain meds, I find that giving around the clock toradol for the first 48 hours post-op cardiac surgery (if platelets are WNL) works 10,000,000% better than the makers of Dex can ever dream their drug accomplishing.

IMO!!


(hmmm, did that make sense?!)

Our CVICU, has increased our usage within the past year. I was wondering if you have read the P.I.? It indicates that Precedex is indicated as a sedative agent. I have been able to administer far less opoids, not to mention, that you can extubate while the patient continues to receive Precedex. I guess troubleshooting can be difficult for some, but you might take the time to educate yourself as Precedex is not a SOLO agent in terms of taking care of both sedation and pain.

Originally Posted by mjl2525

Our CVICU, has increased our usage within the past year. I was wondering if you have read the P.I.? It indicates that Precedex is indicated as a sedative agent. I have been able to administer far less opoids, not to mention, that you can extubate while the patient continues to receive Precedex. I guess troubleshooting can be difficult for some, but you might take the time to educate yourself as Precedex is not a SOLO agent in terms of taking care of both sedation and pain.

Are you kidding?!

I did say at the end of my post you quoted: "hmmmm, did that make sense?"

Apparently, it did not.

If you read my post previous to the one you quoted I am WELL AWARE that Dex alone is NOT meant for pain relief.

The question I was addressing in the particular post that you quoted was...does Dex decrease the need for opiods? Or, is Dex a good adjuvant to opioids?

In my experience, administering a Dex drip post-op DID NOT decrease the NEED for opioids.

In my experience, giving Toradol around the clock for the first 48 hours post-op DID and DOES decrease the NEED for opioids.

1) Dex makers (or whoever) CLAIM that the need for opiods is less when giving their drug.

2) If the makers (or whoever) claim that Dex decreases this opioid need, then Dex can be considered an adjuvant drug just as Toradol is when it comes to enhancing the effects of, or decreasing the need for, opiois.

3) The need for opioids is LESS when given with an adjuvant such as Toradol. Dex is an adjuvant just like Toradol is (according to the makers - or whoever). BUT, the effectiveness of Dex as an adjuvant to opioids is NOT GOOD, in my experience and opinion. At least it is not as good as Toradol.

I NEVER said that Dex is a "solo" anything.

I would agree with begalli that toradol is very effective when given routinely in the first 24-48 hours postop if their creatine and cbc will allow. We will start toradol once the pt. in on CPAP. Oversedation is ess. a non-issue and it gives the patient a steady analgesic effect.

I've have never taken care of fresh open hearts before, but have many thoracotomies for lung CA's or other issues, and Toradol did wonders of the post op pain these folks suffered. Even when opoids didn't seem to help, this drug did almost 100% of the time I have used it. It's great.

Re: Precedex...

i have a patient who is Precedex right now. but it is only for 24 hours. it is used with fentanyl drip on my patient at the same time. i do not see any difference in action/effect on patient.