Dex

[Gator05]

Starting to hear more and more about Precedex. I haven't used it myself, but the people who have rave about it's role in a good anesthetic. I've actually started wondering if the "I can sedate someone just as good as you can, even though I haven't intubated or heck, even bag-masked, anyone in over 2 decades, but I swear the white stuff is perfectly safe" crowd won't skip propofol and move to Dex.

Finally, anyone read the latest Anesthesiology? Thoughts about the neuronal apoptosis??

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[UTSouthwestern]

Haven't read the latest Anesthesiology. We use Precedex frequently for sedation on Neuro interventional radiology, MRI sedation, Burr holes, intracranial lead placements during the craniotomy portion, etc. Also great for ICU sedation especially for our post bypass patients. Works wonders. Still not approved for pedi, and if that article you mentioned has any impact as it probably will, it will probably not be available for the kids.

I have personally seen patients go apneic with dex. Those who had narcotics on board concomittantly were difficult to stimulate, but those who did not have narcotics on board usually were easy to stimulate to breath again.

 

[sones]

Precedex works great in patients in the ICU. Patients can stop breathing and can get quite hypotensive with it. Using it with narcotics makes this tons worse of course. It's not a wonder drug, but it is nice.

 

[Adcadet]

in intubated M/SICU patients in an academic medical center, dex is given a little less than 3% of the time, and most commonly (about 1/3 of the time) along with lorazapam or hydromorphone.

 

[sleepydoc]

i have used it frequently for MAC cases. a 1mcg/kg load with a healthy infusion to start with a little 30mg bolus of ketamine during infiltration during blephs is a great smooth way to do a MAC for a plastic case where you cant use oxygen. that being said, you cant slam in fentanyl and propofol in addition and expect them to breathe.

btw, it is also a good drug for awake fiberoptic intubations... as it has minimal impact on respiratory rate on its own.