dexmetatomadine

franky127 · Apr 23, 2004

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.

amberrn · Apr 23, 2004

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.

Brenna's Dad · Apr 24, 2004

This is a central alpha 2 agonist, like Clonidine, is it not?

Brenna's Dad · Apr 24, 2004

This is a central alpha 2 agonist, like Clonidine, is it not?

jbro · Apr 24, 2004

yes, given iv as an adjuct to anesthesia

jbro · Apr 24, 2004

yes, given iv as an adjuct to anesthesia

gaspassah · Apr 24, 2004

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

gaspassah · Apr 24, 2004

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

mbrian46 · Apr 25, 2004

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............

mbrian46 · Apr 25, 2004

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............

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.