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I'm in private practice and have just started using Dex. Is there a recipe for small boluses at the end of a ped tonsil to smooth the wakeups? Thanks.
 

Mman

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3 mcgs/kg? That seems like an awfully big dose. For a 70 kg adult patient, that would be 210 mcg (or 52.5 mls of the commonly diluted 4 mcg/ml solution).

Do you mean 0.3 mcg/kg? I freely admit I don't really use it as a bolus at the start of a case in peds patient. At the end of the case, a small dose can make a smoother (but slower) wake up possible but nothing remotely as big as what you suggest.
 

countingdays

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I'm in private practice and have just started using Dex. Is there a recipe for small boluses at the end of a ped tonsil to smooth the wakeups? Thanks.
Cote says 0.5 mcg/kg 5 minutes before wakeup decreases emergence delirium but prolongs emergence.
 

Arch Guillotti

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3 mcgs/kg? That seems like an awfully big dose. For a 70 kg adult patient, that would be 210 mcg (or 52.5 mls of the commonly diluted 4 mcg/ml solution).

Do you mean 0.3 mcg/kg? I freely admit I don't really use it as a bolus at the start of a case in peds patient. At the end of the case, a small dose can make a smoother (but slower) wake up possible but nothing remotely as big as what you suggest.
I haven't really used clonidine too much in kids but sometimes I will give it for adoldescent males to prevent a violent wakeup, and have dosed as much as 150 mcg without problems.
 

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I'm an intern who didn't know much about this drug before. However, at the bidding of the attending, I just wrote for it to ease the emergence of a patient in our ICU from his previous week of sedation. I'm excited to see how it works.
 

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I typically work in 2 mcg/kg dexmedetomidine gradually over the course of the case. I think it works quite well and the kids wake up comfortable and typically need little if any narcotic in PACU. Of course, they sleep for a while in PACU with this dose.
 

Jay K

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I'm in private practice and have just started using Dex. Is there a recipe for small boluses at the end of a ped tonsil to smooth the wakeups? Thanks.
At around $60-80/vial of dex, that's gonna be an expensive regimen for peds tonsils. I don't know about you, but I don't even have time to finish charting most of the time for a peds tonsil in PP (especially at the ASC), much less have time to bolus small doses of dex. AND to get the ASC to pay for/supply dex? We're lucky if they don't limit the propofol.

Edit: To say I understand, in no way, did I actually address your actual question or provide any useful information to you.
 
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Mman

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Depends on the schedule. 1 vial can cover a whole lotta wakeups.
Many institutions have policies that prohibit using a single vial on more than 1 patient because each patient gets charged for the whole vial and it would amount to insurance fraud. It would probably need to be divided up in the pharmacy so that each patient could be charged appropriately for only their share.
 

sevoflurane

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Many institutions have policies that prohibit using a single vial on more than 1 patient because each patient gets charged for the whole vial and it would amount to insurance fraud. It would probably need to be divided up in the pharmacy so that each patient could be charged appropriately for only their share.
That's what we do. 10, 20, 40 mcg 10cc syringes are available to us courtesy of pharmacy.
 

Jay K

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Many institutions have policies that prohibit using a single vial on more than 1 patient because each patient gets charged for the whole vial and it would amount to insurance fraud. It would probably need to be divided up in the pharmacy so that each patient could be charged appropriately for only their share.
Nice suggestion - I wonder if our hospital pharmacy directors would be amenable to this recommendation.

Currently we also happen to be short of ketamine. This would also be a good way to extend/maximize our supplies.
 

fakin' the funk

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I typically work in 2 mcg/kg dexmedetomidine gradually over the course of the case. I think it works quite well and the kids wake up comfortable and typically need little if any narcotic in PACU. Of course, they sleep for a while in PACU with this dose.
Sweet DFA79 avatar bro. I miss those guys, I coulda gone for like one more LP before they broke up. Saw them live once, it was just bonkers.
 

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those who have used it, I was wondering, Does the dex work better for preventing emergence delerium than other commonly used methods? (i.e. High dose narcotics in teens titrated to rr of 6-8; or a bolus of propofol after extubation in younger kids if they wake up wild) Is anyone using the dex instead of these other methods because they feel it is safer (less resp depression?) Does the skill level of the pacu nurses affect how likely you are to use dex instead of high dose narcotics or a dose of propofol on extubation? (both of which are used frequently at my institution without complications, but maybe it is a luxury in a place with excellent pacu nurses, as well enough ORs running that we almost always have an attending who can leave the resident during a non-critical part of the case and run to the pacu if needed? Maybe the high dose narcotic/propofol on emergence strategy would not be feasible if I were the only anesthesiologist at a surgery center doing 12 tonsils a day? Maybe in that case the dex would be cost effective?)
 

bluewater

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0.25 mcgs/kg given 5-10 mins before wakeup