Any reason why an ICU pt is on precedex rather than propofol?

[Omegadramon]

A quick google search tells me that precedex doesn't cause respiratory depression or requires the constant attention of propofol and it's good for extubation (but what do I know, I'm just a brownnosing p1).

On the other hand, everytime we have a patient on it, I've got to keep on making iv bags for them every 2-3 hrs (This week it was few pts on 400mcg/200ml ns and 800mcg/400ml ns). I dunno, it seems inefficient or maybe those folks are complicated. I'm sure it costs a boatload (but then again, we carry only diprivan on formulary...isn't prop generic?...we must get some sort of bargain...)

I wonder what the anesthesia forums say about this....

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[Priapism321]

No good evidence for dexmedetomidine in ICU sedation. Awake intubations, perhaps. Planned extubation within the next 24 hours, maybe.

10 times as expensive as propofol.

 

[Priapism321]

Oh, and 38 times the cost of midazolam, since it represents the drug class of choice for ICU sedation.

 

[Omegadramon]

Well if doesn't have any advantage in ICU sedation, does it justify its cost in cardiac cases or other procedures?

 

[Priapism321]

Well if doesn't have any advantage in ICU sedation, does it justify its cost in cardiac cases or other procedures?

Doesn't have evidence to support its use in anything in my opinion, but may be rational for awake/non-intubated ventriculostomy placements, awake intubations, or weaning an agitated patient off a ventilator (12 - 24 hours maximum).

 

[Omegadramon]

Well, thanks for the info. It seems like the folks in my hospital don't care about its cost...we now order it in cases of 25 and we've been handing it out like candy recently.

 

[ItsOverZyvox]

Good Ole Dex... before Dexmedetomidine came on board, clonidine was used in its place in cardiac surgeries. Dex, an Alpha 2 agonist does provide antihypertensive (after a brief period of refractory hypertension)and bradycardic effects which can be beneficial. Also, it does provide effective sedation and a decreased need for opioids which can be beneficial in respiration. And for neuro surgery that requires arousable sedation, Precedex can be preferred over other anesthetic agents.

Nurses love it because it's easier to arouse the patient for scheduled assessment while patient is on Prededex over Propofol.

But yes, Precedex is about 10 times the cost of Propofol. Brand diprivan can actually cost less than generic propofol with the right contract.

So how should we propose we use Propofol over Precedex?

 

[ItsOverZyvox]

Well, thanks for the info. It seems like the folks in my hospital don't care about its cost...we now order it in cases of 25 and we've been handing it out like candy recently.

Your DOP may not care about it but I promise you your administration does.

 

[Omegadramon]

I may be exaggerating it's use based on a few days working. We had next to nobody on TPNs, so I had time to pay attention to orders I was making.

We make sure we put propofol everywhere. Anesthesia carts, heart carts, override access in pyxis in every ICU.

Might have to start putting some next to the coffee pots....

 

[njac]

with long term propofol use you get green pee!

 

[bigpharmD]

Doesn't have evidence to support its use in anything in my opinion, but may be rational for awake/non-intubated ventriculostomy placements, awake intubations, or weaning an agitated patient off a ventilator (12 - 24 hours maximum).

They could be trying to give their anesthesia residents experience using the drug.....well at least that is an excuse I have heard before...

 

[wee eng]

Long term propofol infusions may lead to Propofol Infusion Syndrome (PRIS) which can be devastating or fatal. Midazolam and other benzodiazepines should be used with caution in older patients. Many anesthesiologists omit midazolam for patients over 70 due to concerns over cognitive dysfunction post treatment. Studies show dexmetetomidine to be equal to propofol or midazolam for sedation in the ICU. Dex also has the feature of better rousability, which may or may not be a concern. Cost is certainly one issue, but should always be considered in the context of cost-benefit. Treatment should always be individualized for the patient.

 

[SELDANE]

I don't mean to be so jaded but maybe the drug rep pushing Precedex in your neck of the woods has a million dollar smile and a body that won't quit.