Precedex

We are using Precedex for our post CABG patients. Dose - 0.2 to 0.7 mcg/kg/hr. Usual side effect is hypotension. I like it better than Diprivan because the patient is awake and neuro status can be assessed. But, we just use it for a span of 24 hrs. No studies have been done re: its effectivenes after 24 hrs.

Our CICU has been using Precedex for at least a 1-1/2 years now for post-op CAB's. At first we had problems with the bolus doses causing hypotension so we do not give bolus doses anymore. When I receive a patient post op that is borderline hypertensive (SBP 140's), I start Precedex a the 0.5mg/kg/hr rate. No bolus. Our CVT orders read to start Nipride for SPB > 150, Precedex usually helps me to advert starting Nipide.

I have used Precedex at another facility and loved it. We even occasionally would use it for mild alchohol withdrawls. It didn't always work, but I don't know of any med that always works. Now I'm at a new facility and am given the task of instituting a Precedex protocol. I have the one from where I worked before, but would like to look at others as well. Does anyone have a protocol that they would be willing to share as reference?

We use Precedex for our post AVR's. Usually the pt is on 0.5-0.7 mcg/kg/hr upon arrival to the unit, if not we will maintain the pt on Propofol until the bag arrives from pharmacy and then hang the Precedex and after 20 or 30 minutes stop the propofol. Like another post menitioned, sometimes it works sometimes it doesn't - but when it does work I do like it. We titrate the Precedex by 0.2 mcg/kg/hr every 30 min until the pt can follow commands and we can extubate on a continuous infusion rate up to 0.5mcg/kg/hr.

Can anyone else elaborate on the alpha 2 agonist properties?

Our ICU + CVICU have a Sedation/Analgesia protocol that includes Precedex if the physician signs that section of it.

We start at 0.2 mcg/kg/hr, able to titrate to a max of 1.2 mcg/kg/hr.

The level of sedation we aim for is for the pt to be pretty much asleep if no one is in the room, and easily arousable if you stimulate them. They can still communicate wants/needs/pain.

Using Precedex, we don't need to do a sedation vacation. We can check neuro status anytime that we want. Also, Precedex doesn't affect respiratory drive, so they can still be on it when extubated.

I've only used it so far in my hospital's Medical ICU, not in our CVICU (CABG pts).

So far I feel like it's a wonder drug with my experiences with it.

When I work next week I'll try to remember to email myself a copy of my hospital's Sedation/Analgesia protocol to put on here. :)

For those of you using precedex for open heart recovery-- Are your open hearts already reversed when they come out to you? I can't imagine using precedex for these people! Where I work we reverse the patient when they meet certain requirements (CT output, oxygenation, temp, etc), and turn the propofol off an hour after administering reversals. I see patients wide awake on precedex (not hearts, other patients) quite often, and can't imagine using it with patients that are as touchy as fresh hearts. With propofol I know they aren't waking up until I want them to (ie: I turn the drug off).

I do not like Precedex as it usually does not work well at all. The patients are mostly too awake and still agitated. Also, the hypotension issue.

We've been using it for 2-3 yrs on CABG's and valve repairs when the patient goes wild off sedation; it doesn't always work, as with any drug . . . but for many patients, we're able to extubate with the dex on and it has shortened the time on the vent in our ICU. The dosage range we use is 0.2 - 1.5 .

We use Precedex in our CVICU at o.2 to 1.2 for up to 24 hours on pts who are generally aggitated or as a bridge for those who need some help getting to extubation. I really like being able to wake the pt for assessment and still seeing genuine rest when they are not stimulated. Seems like less of a lingering med-hangover than Propofol, too.

The ability to bolus Propofol is its one big upside for situations that require some extra sedation in a hurry.

We use both, and each has its benifits in specific situations.

Our CVICU has had pretty poor results with Precedex alone. If we run it with low dose Propofol it works pretty well. Most of our physicians do not prefer to use it. We are an academic university with > 800 beds. Most of the uncomplicated heart surgery patients are extubated within a six hour window of time. The aortic valve/aneurysms have been tried on Precedex and do not do well--still have pump head most of the time. We had someone on 1.7 mcg/kg/hr who still had 5 nurses holding him down until Propofol could be given.

I heard its more expensive than propofol but was useful during

the recent propofol shortage. Its supposed to cause less icu

delirium. But when we tried to use it on our unit it didn't

work so well, the pts were still agitated trying to self extubate.

I did read somewhere if you add a lose dose fentanyl gtt

that it is more effective in decreasing agitation. Anyone else?

I heard its more expensive than propofol but was useful during

the recent propofol shortage. Its supposed to cause less icu

delirium. But when we tried to use it on our unit it didn't

work so well, the pts were still agitated trying to self extubate.

I did read somewhere if you add a lose dose fentanyl gtt

that it is more effective in decreasing agitation. Anyone else?

It's useful if it's started in surgery and used as a bridge to extubation, its usually not started correctly. The patient needs to be kept in a dim quiet room without a lot of stimulation and usually helps if they're on a benzo and/or narcotic because it's potentiates the effects. I think it's only FDA approved for 24 hours but some docs will use it for days and days...