dexmetatomadine

pasgasser · Apr 25, 2004

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.

jbro · Apr 25, 2004

so the analgesia is adequete without having to use any opiods at all?

jbro · Apr 25, 2004

so the analgesia is adequete without having to use any opiods at all?

pasgasser · Apr 25, 2004

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.

pasgasser · Apr 25, 2004

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.

keermie · Apr 26, 2004

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.

Tenesma · Apr 26, 2004

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

heartICU · May 12, 2005

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?

MrSleepy1 · Dec 12, 2008

Used 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.

MrSleepy1 · Dec 12, 2008

I'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.

msjessegirl · Dec 17, 2008

I'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.

krzysiu · Dec 20, 2008

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.

Personally, 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...