dexmetatomadine - page 2
is anyone using dexmetatomadine in their practice, if so how, and what kind of results are you seeing in terms of decreased mac and opiod use? we discussed it a little in class and seems like a good... Read More
Dec 12, '08Used Precedex on a Bronch today. Geriatric pt I think he was 85. His baseline was crappy. BP 80's HR 110 and his Crit was 1.2. I didn't want to use any Diazepam or narcotics b/c of his renal issues. Ran Precedex at 1.0 mcg/kg/hr and bumped with a little Neo and he maintained BP and HR. Of course he was being stimulated pretty well for the Bx but no narcotics or Benzo's at all. Recovered him in @ 20 minutes. Propofol would have tanked this guy.
Dec 12, '08I've MAC'd with it but not as a stand alone. Usually I start the infusion at 1mcg/kg/hr and bump a low dose Versed 0.25-0.5mg(unless pt has a Hx and I may go a little higher). The fact that I can cut my Narcotics back and keep them breathing makes it easier. I don't load at all because it can be unpredictable on their hemodynamics. Oterwise it works well.
Dec 17, '08I'm not sure exactly what he meant about somebody "walking out of the room" right after open heart surgery, seems unlikely, but I did want to comment that not all open heart surgery patients are put on bypass anymore. We have one surgeon who rarely puts his open hearts on bypass. There's a very cool little device that resembles an umbrella that can block the opening on the aorta while attaching the graft and then unravels so it can be pulled back out of a very small opening. So the heart continues to beat throughout the entire procedure. Obviously the bypass remains available in case its needed emergently but that doesn't happen very often. He also does the robotic ACB but it's only usable on a small portion of cases at the moment.
But I digress.... (I just think the surgeries are cool). We use precedex a lot in our CVICU. Some of the MDA's like it and some don't. We never bolus. It seems to bottom just about everybody out when we do. Rates from 0.2 to 0.7 mcg/kg/hr work well. Although it seems that it either works really well, or not at all. We really like it on our patients that have preexisting anxiety issues. It's only about 50/50 for reducing opiod usage in my experience.
Dec 19, '08Quote from franky127Personally, don't have too much experience with the stuff. However, definitely seems like people either love it or hate it. As far as the DTs are concerned. I thought you shouldn't use it for more than 24 hrs? Who knows...
I've also heard of some research being done on precedex and DT patients, but with increased dosages. The manufacturer recomends not more than .7 mcg/kg/hr if I'm not mistaking. I've heard, though, that doses up to 2-3 mcg are currently being tested.
Dec 22, '08Quote from Brenna's DadYes and no. It is a central A2 agonist, but at high doses (>2mcg/kg) it loses its selectivity and you get an A1 agonism that will cause hypertension and reflex bradycardia.This is a central alpha 2 agonist, like Clonidine, is it not?