BoBorn, the hospital where I moonlight is also having distrust of precedex, for the same reasons. In fact, I think they have decied not go use it anymore at all.
Our usualy protocol is that the pt comes out on diprivan, once they are warm, we follow an extubation protocl, if pt meets all criteria, CT drng is WNL, POx OK, CO WNL, etc..., we wean off diprivan over 30 minutes, reverse and extubate, usually within 4 hours.
We start a MSO4 IVP q3h around the clock (ATC) as soon as possible. ONce extubated for 4 hours, and not nauseous, we start perc's 1-2 q4h ATC, yes we wake people up for it. IT is quite effective. For pain unrelieved by the perc's, we also have a prn MSO4, the ATC MSO4 is D/C once we know the pt can tolerate po perc's. For LIMA's we find that toradol first dose 60mg, followed by 30 q6h x 3 works extrememly well, pt must have good renal function and not be bleeding or "oozing."
Interesting to see how everyone else does it. Of course, if anyone has allergies, we modify the drugs as appropo.