We just had an in-service on Precedex and I can tell you that facilitation of intubation is definitely NOT one of the labeled indications for this drug. Those docs are either very ignorant or just plain crazy- the outcome of that intubation attempt is definitely their fault and not yours. I think some docs just like to use new(er) drugs like Precedex because it's the latest and greatest new thing and they just read all sorts of literature about how well it works. Well, evidence-based practice is all well and good, but sometimes they overlook the individual patient (as opposed to a population of patients in a study) when making decisions about which sedative to use. In my unit, we usually use Precedex for intubated patients who are closer to being weaned off the vent (ie- going on PS trials), but still have some intolerance of the ETT and/or being on the vent itself. Precedex is good alternative to Propofol and Versed in the sense that it doesn't have the respiratory suppresant effect that Propofol and Versed do. Plus, if (and that is, only if) Precedex actually works for a particular patient (there's a good percentage of patients in which it does not work), then you can also do accurate neuro assessments on them while maintaining them at a comfortable RASS of -1. Precedex is supposed to keep patients in a state where they are resting comfortably (RASS of -1), but they can wake up and follow commands when told to do so. Precedex also doesn't have as much of a hypotensive effect on patients in comparison to drugs such as Propofol.
So in my experience, Precedex is really hit or miss. There are some patients who will still be buck-wild on it, but for the patients in which Precedex is therapeutic, it's like dealing with a sleeping lion- they can become agitated when stimulated, but they go back to resting after a period of not being bothered.