dexmetatomadine

  1. 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 drug, but i haven't heard of anyone using it much and i was wondering why.
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  2. 17 Comments

  3. by   franky127
    I have had some experience with precedex in a CV ICU. It seems the CV docs like it a little better than propofol nowadays. I, however, don't really care for the drug. It has a lot of hemodynamic complications, especially during the loading dose. I've had both increases and decreases in BP to the extreme, requiring discontinuation. Its also not quite as handy as propofol because you can't just give a little "bump" of 20-30 mg here and there.

    I've also extubated a few hearts while they were still on small doses of precedex, which is a plus.

    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.
  4. by   amberrn
    This is my first time posting. I start school in August at Mt. Marty in south dakota. I am not sure I can give you the depth of informtion you are looking for on Precedex, but we have one main cardiovascular surgeon who uses it on all of his hearts. When the patient gets to me they have already had it started at 8 ccs an hour. I don't know why but our anesthesia providers rarely program the pumps for mcs/kg/hour. So no matter the size the patient has it going at 8 ccs n hour. I like the drug. Patients remian more calm as they emerge, and seem easier to extubate. Sometimes I have had to turn it off to get patients to wake up more. I can frequently run it at the lower dose of .2-.4 mcs/kg /hr, occasionally they need to receive a little more. Thanks to all who respond on this board, it got me through the application and interview process. I really appreciate all of the advice and I love the clinical discussions- however most of them are over my head at this point. I can't wait to learn more and be able to participate more.
    I have also found that I rarely have to use morphine or versed with the patients.
    Last edit by amberrn on Apr 23, '04
  5. by   Brenna's Dad
    This is a central alpha 2 agonist, like Clonidine, is it not?
  6. by   jbro
    yes, given iv as an adjuct to anesthesia
  7. by   gaspassah
    when i was working in the icu the rep came to show us the drug. most ppl say that while your using it for sedation, the patient will sleep, they can be aroused for assessment, then when not stimulated they will go back to sleep.
    but i have never seen it in use personally.
    d
  8. by   mbrian46
    We used Precedex in the neurosurgical ICU where I used to work. From my experience with neuro patients it did not work very well on this patient population. We would extend the loading dose to about 20 min. instead of the recommended 10 min., but still would see hypotension in a majority of the patients. This is an undesirable side effect especially in neuro pts. with ICP issues. Plus, when pts. became agitated it would take longer for them to calm down on Precedex (unlike Propofol, where it just takes a few extra bumps to sedate them). The range for Precedex is .3-.7 mcg/kg/h (I think), so there's not much room for titration. Propofol still rules............
  9. by   pasgasser
    My precedex use hs been limited to awake craniotomies. It works well because the sedation is good but respiratory drive is not decreased so no increase in PaCO2 and a intra-op neuro exam is easy to obtain. I agree with the hypotension with the loading dose to overcome this I don't load it. I use midazolam pre-op, turn the infusion on upon entry into the OR, and use propofol boluses for pinning and turning the bone flap. I have had great success with this routine. I have a partner who has successfully used a similar protocol for totoal hip arthroplasty in elderly pt's using a SAB.
  10. by   jbro
    so the analgesia is adequete without having to use any opiods at all?
  11. by   pasgasser
    Quote from jbro
    so the analgesia is adequete without having to use any opiods at all?
    The surgeon injects the scalp with local/epi and no further analgesic is necessary. At times colleages have needed low dose remi or propofol to aid with the anesthetic but I have not needed these to date.
  12. by   keermie
    Dr. Ramsey (ala the Ramsey sedation scale) came and spoke about Precedex. Amongst his lecture was an open heart, who woke up from surgery and promptly walked out of the room on his hemodynamic drips and precedex infusing when prompted by voice. (A pic is worth a 1000 words). He also mentioned that he has used it for involved surgery as the sole anesthetic without the need for supplemental ventilation. It is like clonidine, but is much more alpha 2 specific. I have noticed lability with a loading dose, and a lot of people shy away from boluses; however, the first clinical trials are starting for neuraxial use, which are promising.
  13. by   Tenesma
    a few things:

    open heart surgery implies going on bypass (or else you wouldn't be able to open the heart)... nobody can walk out of bypass!!!! the circulatory system is still in a semi-state of shock and would never tolerate the standing position...

    precedex (dexmedetomidine) cannot be used as the sole anesthetic - because it isn't an anesthetic. it is a sedative... with some mild analgesic properties.... while it will reduce the need for opioids, propofol or volatiles - it doesn't replace it

    i think it is a great drug with much promise - but some people are overselling it a bit with not much clinical information available yet
  14. by   heartICU
    I know this is an old thread, but I am just looking to see if anyone has used dex recently. I have used it twice in the past few weeks, with mixed results. Both were for MAC cases, and I am looking to see if anyone has had an exceptionally good or bad experience with it for use during surgery, NOT in the postop phase.

    I am planning to give it another whirl tomorrow on a different kind of case (going to use it for sedation on a patient getting a radical retro prostatectomy under epidural). Any thoughts?

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