Precedex gtts in the PICU

Pediatric Critical Care Columnist · Sep 3, 2010

We're not using it. (I'm not even sure it's approved for use in Canada.) The low HR effect would be very undesirable on our unit where 2/3 of our kiddos are post-op CV surgical patients so I doubt we'd even consider making it a common item.

Sari2009 · Sep 5, 2010

I have had a lot of experience with precedex gtts in the PICU. I personally have not seen much bradycardia and have used it in many post op hearts. You may see some hypotension at higher doses however the half life is so short that if you titrate down or just put it on hold for a moment it is very transient. Remember precedex is meant to work as adjunct to opiate and even benzo not as single agent sedation. It helps to use a loading dose over 15 minutes and then titrate from 0.2 all the way to 1 mcg/kg/minute although the package insert will say you max out at 0.7mcg/kg/minute. It will definately potentiate opiate effect so once you have it going you will need to titrate down your opiate. It causes almost no resp depression so it is helpfull in painfull yet not intubated patients such as spinal fusion and craniofacial surgeries. It is not the end all be all but when it works it works. Good luck with it.

harryalexx · Oct 18, 2010

I work in a CV (CT) peds ICU and we use Precedex (dexmedetomadine) quite frequently on the hard-to-sedate post-op children. We're a large center on the West Coast and do a lot of cases. I've found that when titrating up - even quickly - that the bradycardia issues aren't such a big deal. When they're super-agitated with HRs 180+, the effect isn't very noticeable. I will say, though, that it isn't the first line drug of choice for most patients.

We're currently working on a sedation protocol, and I believe that it is written in the "staged sedation" for post-op day 4 or 5 if the typical morphine/ativan +/- fentanyl aren't working.

For what it's worth, I've had only the best experience with Precedex. Especially considering that you can extubate on Precedex, it helps get through the critical/dangerous intubated periods. Look up some of the clinical trials - the drug is associated with fewer ICU days, intubated days, and shorter hospital stays in general. There isn't much that's peds specific yet, though, and that's saddening

Hope that's helpful for you!

heartkid17 · Nov 8, 2010

I work in a pediatric CICU at a large metro hospital and we use Precedex all the time. It is our main form of sedation especially in post operative patients (in addition to a fentanyl infusion). I think it works great. You will see break through periods of agitation, but they normally calm down by themselves.

As far as bradycardia - We do use it for certain episodes of tachycardia to purposely bring down heart rates and I have seen cases where a patient was needed to be paced out of a precedex bradycardia. If you are giving boluses you can normally avoid this by properly diluting it and infusing it at least over 10 minutes.

I think it is also great to use during extubation!

kessadawn, BSN, RN · Nov 12, 2010

This is some good information, thank you all!