What is your ICU sedation med of choice? Our Critical Care Surgery team is turning to precede almost exclusively and it makes me cringe! It works on some patients but others it doesn't work on and is never going to work on!!

one of the residents was telling me that all level 1 trauma hospitals are basically exclusively using preceded for sedation now.


93 Posts

We mainly use propofol, but will use versed instead if the pt BP doesnt tolerate it. And some chronic drug users require both! For rapid intubation we use atomidate. I cant say I've ever used preceded, or even heard of it? Did you mean to say precedex?


1,698 Posts

No way. We almost always use propofol. And we are a level 1 trauma.


42 Posts

Specializes in ICU. Has 5 years experience.

I am happy to say that we nearly always use propofol and no longer carry Precedex in my facility. There were so many patients who were WILD and acted like they weren't on any sedation at all while on Precedex. It always seemed really hit or miss.

MunoRN, RN

8,058 Posts

Specializes in Critical Care. Has 10 years experience.

Precedex is probably better described as an alternative to sedation, as it's purpose is to give something that can keep patients calm that can continue through extubation rather than have to be weaned prior to extubation. It's intended use is to help open heart patients through the waking-up-but-still-intubated portion of their recovery. Typically, I don't give post open hearts any sedation prior to extubation, only analgesia, our goal is a RASS of 0. When I do need to sedate an OHS patient prior to extubation, precedex can sometimes negate the need for sedation, although it's effect seems to vary widely from patient to patient, with some patients showing no apparent effects even at high doses.

When it first came out, we tried it on everyone and basically found it wasn't all that useful and certainly isn't something that can be used in place of actual sedation.


1,549 Posts

Specializes in Post Anesthesia. Has 30 years experience.

Propofol is almost always our first choice, but fentanyl and Versed drips are also used. A lot depends on how long you expect to need sedation, and if analgesia is also required-(thus the fentanyl). Advantage of propofol- short acting, less resp depression, and easily titrated. The problems are "Diprovan drooling"-massive oral secreations, propofol fever- it always seems to happen after 24-48hrs after milk of amnesia is started, and the potential for line infections-propofol makes a great culture medium for lots of hungry bugs. After reading the posts about Precedex, I'm glad we don't keep it in formulary- it sounds pretty sketchy for me to depend on it to keep my aggitated patients ETT/a-Line in place.

EMSnut45, BSN, RN, EMT-P

2 Articles; 178 Posts

Specializes in ICU and EMS. Has 14 years experience.

Precedex is not intended to be the sole drug for sedation when used for longer term (not immediately prior to extubation). By using precedex in addition to another sedative, the amount of that sedative can typically be reduced significantly (sometimes by 50-75%) to the point where the pt can be interactive with their surroundings. This info came from several inservices from a drug rep for precedex as well as personal experience.

I've found it to be very effective if combined with fentanyl or versed pushes or low dose fentanyl or propofol drips. Also very useful to "chill out" the non-intubated ETOH withdraw pts. The only complaint I have about it is the bradycardia that it can cause.


41 Posts

We use a lot of propofol, sometimes versed. I've only used precedex once and my pt brady'd down to 30's, our docs don't seem to like it much, although our pharmacists are always talking about it. I work for a small 12 bed community ICU.


6 Posts

Ugh thanks :) just what i needed to hear! Drives me crazy! We have a new Critical Care Surgery (Trauma) attending who is now using preceded for ETOH withdrawal. Nope....not going to work....EVER. give the poor guy some benzos STAT!


128 Posts

Specializes in ICU. Has 4 years experience.

Propofol for short term sedation, midazolam for long term sedation. I HATE dexmedetomidine. 99% of the time the way it is prescribed is not the way the drug is meant to be used (eg., is written up instead of propofol for a neuro patient trying to rip every tube and line out with no plans for extubation), and I find the bradycardia it causes even at tiny doses to be very disturbing - you can't even have it running at an effective dose due to the side effects. Hate it!!


379 Posts

Specializes in critical care.

Propofol. Or sometimes fentanyl with prn ativan. We will use dex when trying to extubate a patient who wakes up WILD when you turn the propofol off. In our facility, dex absolutely cannot be used for longer than the fda-approved 24 hours.

Specializes in SICU, trauma, neuro. Has 16 years experience.

We are level 1 trauma, and usually use Propofol, in conjunction with a fentanyl CADD for pain. Occasionally if the fentanyl alone achieves a RASS of 0 or -1, we'll skip the sedation and just use the CADD (especially in the elderly.) 2nd line drug in our facility is Versed, again with a CADD. We have Precedex, and in the year and a half I've been there I've never used it myself. I think I've heard of one or two other pts being on it during my shifts.

The nice thing about propofol is it can be weaned so quickly. The pt can wake up soon after we pause it--say we're not sure if they're having neuro changes or are just oversedated. Or if the neurosurg resident shows up for early a.m. rounds at an odd time, we can wake the pt up for the resident to do his/her own exam.