Would the use of Precedex expand the group of non-anesthesiologist from administered deep sedataion?

[GCS8]

The profile of precedex is such that respiratory drive is preserved unlike propofol, fentanyl, ketamine, and midazolam. Yet it still provides sedation, hypnosis, and analgesia.

Would it be fair to speculate that a more generalized use of precedex and the expiration of its patent in 2019 (current cost is $40/vial) driving its cost down will possibly make it dummy proof to the extent that providers like periodontist could safely administer deep sedation in their office?

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[PhansterZ]

The money isn’t putting people to sleep, it’s waking people up.

What if the patient loses an airway, will a periodontist (since you brought it up) be able to intubate, or worst case scenario, perform an emergency crycothyrotomy?

 

[GCS8]

The money isn’t putting people to sleep, it’s waking people up.

What if the patient loses an airway, will a periodontist (since you brought it up) be able to intubate, or worst case scenario, perform an emergency crycothyrotomy?

Precedex doesn't depress respiration

 

[PhansterZ]

Precedex doesn't depress respiration

What residency are you in? I'm curious.

 

[thewingman]

While precedex doesn’t cause respiratory depression, it is not an ideal sedation medical for 2 reasons. First, the rousble effects result in the patients waking up as soon as they are moved or hear a drill - even with higher doses. Secondly, there can be profound bradycardia and hypotension that can result, which I don’t think any periodontist would be able to handle.

We already see people dying in Dentist offices because of weekend CE course cowboys. Moreover, there are deaths occurring in dental offices in the hands of trained anesthesiologist. I am probably in the minority, but I don’t think Dentist/periodontist should be doing sedation. Even the Omfs that I know that have been sedating patients in residency for 4 years are stressed when performing there procedures. Dentist/perio/etc should focus on what they are good at - dentistry - and leave high risk procedures to people trained in anesthesia with airway/resuscitation training. You have one major event and there goes your license.

 

[Awarara]

precedex is expensive. mainly see it used in the icu here. even if it gets cheaper later, i don't see why it should be used... has to be in a drip and lasts longer in the system

every procedure done by a periodontist or general dentist should be able to handled with standard meds like nitrous and valium. too many dentists don't use these and don't realize how effective they are. if your patient needs more than that, it's not even worth it to treat that patient. if i was currently practicing dentistry, i feel like i would be able to treat most patients like this, and if not, that is a major problem patient i would rather not have. i also would not want to deal with getting certified in iv sedation, malpractice insurance, and knowing if something goes wrong, you're pretty much screwed.

 

[vellnueve]

It's expensive and it takes patients a while to wake up.

As noted above, respiratory depression is not an issue. The other two are issues for most practice scenarios.

 

[Localnative]

The profile of precedex is such that respiratory drive is preserved unlike propofol, fentanyl, ketamine, and midazolam. Yet it still provides sedation, hypnosis, and analgesia.

Would it be fair to speculate that a more generalized use of precedex and the expiration of its patent in 2019 (current cost is $40/vial) driving its cost down will possibly make it dummy proof to the extent that providers like periodontist could safely administer deep sedation in their office?

Been practicing for a number of years. Can't say that any of my GP colleagues know jack about the pharmacology of vasopressors or how to manage an ischemic stroke when profound hypotension arises

 

[The Anhedonia]

While precedex doesn’t cause respiratory depression, it is not an ideal sedation medical for 2 reasons. First, the rousble effects result in the patients waking up as soon as they are moved or hear a drill - even with higher doses. Secondly, there can be profound bradycardia and hypotension that can result, which I don’t think any periodontist would be able to handle.

We already see people dying in Dentist offices because of weekend CE course cowboys. Moreover, there are deaths occurring in dental offices in the hands of trained anesthesiologist. I am probably in the minority, but I don’t think Dentist/periodontist should be doing sedation. Even the Omfs that I know that have been sedating patients in residency for 4 years are stressed when performing there procedures. Dentist/perio/etc should focus on what they are good at - dentistry - and leave high risk procedures to people trained in anesthesia with airway/resuscitation training. You have one major event and there goes your license.

echoing thewingman, precedex (like every drug) is not without its own set of side effects. the bradycardia from precedex can be profound and for it to be really hypnotic you need to run at high doses (>0.7 mcg/kg/hr)

Also - keep this recent piece of info in mind - out-patient sedation (whether or not you use big guns like propofol) has been under assault by the ABA for years and the threat has become increasingly severe --> OMFS may soon require 8 months of anesthesia training [OMFS Anesthesia becoming 8 months....].

The availability of precedex wont make anesthesia access or administration easier by any means.

 

[Pennywisdom]

There are a handful of weekend course warriors out there, especially in California, who are already all over this drug. It's scary.

 

[Van Der Woude]

echoing thewingman, precedex (like every drug) is not without its own set of side effects. the bradycardia from precedex can be profound and for it to be really hypnotic you need to run at high doses (>0.7 mcg/kg/hr)

Also - keep this recent piece of info in mind - out-patient sedation (whether or not you use big guns like propofol) has been under assault by the ABA for years and the threat has become increasingly severe --> OMFS may soon require 8 months of anesthesia training [OMFS Anesthesia becoming 8 months....].

The availability of precedex wont make things anesthesia access or administration easier by any means.

There any studies that look at (death/ provider #) ratios from anesthesia performed by anesthesiologists/crnas/assistants/OMFS with ASA classifications serving as a confounders? This way we can see who really needs more training.

 

[UncUndergrad1]

precedex is still a profound systemic depressor, can cause rapid hypotension and bradycardia, and you can lose the airway despite RR. Furthermore, it puts some people into a damn near comatose sleep. If general dentist use precedex, theyll kill people.

 

[UncUndergrad1]

furthermore, not to be a dick, but the fact that you're here asking that, focusing on the lack of RR depression, shows that you neither researched this drug or understand complex anesthesia physiology, and it all the more reason why you should absolutely not use it

 

[TN123]

Can I ask what procedures do perio do that is stimulating enough to need a deep sedation?

 

[UncUndergrad1]

Can I ask what procedures do perio do that is stimulating enough to need a deep sedation?

Spend 2 hours on an extraction or single unit implant

 

[Sublimazing]

Instead of precedex you can use Rocuronium and Sugammadex. You alternate bolusing each medication in rapid and repeated succession that allows for spontaneous ventilation.

 

[Big Time Hoosier]

Instead of precedex you can use Rocuronium and Sugammadex. You alternate bolusing each medication in rapid and repeated succession that allows for spontaneous ventilation.

Or use half a bottle of this...

I wouldn't know personally because I don't drink, but there're people that swear by the stuff.

Big Hoss