Perfect dosing of precedex?

[ucsfgaspain]

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So I'm somewhat of a dinosaur and have been pretty inexperienced with dexemetomidine (Sp?). The typical dose of 1 ug/kg without running an infusion seems to leave my patients snockered after the case. If I'm using it as an adjunct especially in my pedi population, does anyone have a dosage that they give that is effective for preventing emergence delirium, but doesn't make the kid sleep all day in the PACU? Thanks.

 

[coprolalia]

So I'm somewhat of a dinosaur and have been pretty inexperienced with dexemetomidine (Sp?). The typical dose of 1 ug/kg without running an infusion seems to leave my patients snockered after the case. If I'm using it as an adjunct especially in my pedi population, does anyone have a dosage that they give that is effective for preventing emergence delirium, but doesn't make the kid sleep all day in the PACU? Thanks.

Run it at 1 mcg/kg/hr for about 20 minutes as the "loading" infusion. Watch for bradycardia (why I don't use it typically in kids, personally... especially tiny ones). Then, turn it down to 0.5-0.7 mcg/kg/hr during the case. With about 45 minutes left in the case, turn it down again to 0.3 mcg/kg/hr. As the last suture is going in, turn it off. This should solve the problem.

-copro

 

[cubs3canes]

1st Dexmedetomidine

2nd ICU ventilated patients shown in MENDS trial dose is 0.74 mcg/kg/hr

3rd Awake intubations, I like 1 mcg/kg load over 10 minutes, then 0.5 mcg/kg/hr.

We are now doing awake VATS in sick as **** cancer patients and pleurodesing (sp) them with dex and versed. Versed 1mg IV, then load of dex as above. We usually run it closer to 0.6 mcg/kg/hr. Local at site. The patients do well and appreciate not dying with all of that pleuritic fluid.

 

[Hockeyguy]

We are now doing awake VATS in sick as **** cancer patients and pleurodesing (sp) them with dex and versed. Versed 1mg IV, then load of dex as above. We usually run it closer to 0.6 mcg/kg/hr. Local at site. The patients do well and appreciate not dying with all of that pleuritic fluid.

Nice. I'm on CT now with some pretty cool attendings I am sure would let me do this as these cases are frequently on the board. Can you give anymore specifics or any problems you've run into?

MC

 

[cubs3canes]

Sure. The surgeon has to want to do it this way. They have to be able to handle not having the lung down.

1st Versed 2mg (if they can handle it). Start Dex load in holding 1 mcg/kg over 10 minutes.

2nd bring to OR

3rd Connect monitors and have patient position themselves (lateral decubitus).

4th Finish load, start dex at 0.5 mcg/kg/HOUR. Surgeon place Bupivacaine before incision.

5th Watch patient.

The surgeon at my institution likes this because of the negative perssure ventilation. He says that during positive pressure ventilation, the powder does not spread as well.

Good luck
Cubs