What is it good for?
Although approved only
for ICU sedation at present, dexmedetomidine works great in the OR as a titratable
sedative that has minimal respiratory depressant effects. I recommend it for patients that you’re
afraid of oversedating due to airway issues, or that you want to have be
quickly responsive (eg. awake craniotomies, bariatrics, carotids, etc).
There are side effects, and they can be avoided (or minimized) by
dosing carefully, and by avoiding (or minimizing) the concommitant use of
Here's what I've come up with for dosing. Enjoy!
- Precedex comes in 2mL,
200mcg vials (which cost about $55 a pop)
- Dilute the drug to a
volume of 50ml which gives you a final concentration of 4mcg/mL aka 0.004mg/mL
- Load with 0.5mcg/kg over
- Maintenance rate is 0.2-0.8mcg/kg/hr
(NOT per minute)
- I generally start at
0.5mcg/kg/hr and titrate up or down from there
- Remember that this agent
has a "MAC sparing" effect, so you'll need less gas. BIS can be very
helpful with titration
- Beware the manufacturer's
recommendation to load 1mcg/kg over 10 minutes or you'll end up with hypotension
- IF you gave a proper
load prior to stimulation, you can avoid other sedatives, especially if doing
- Thanks to Dr. John Basile
for the inspiration!
Suggestions for additions/improvements?
Please email the management at firstname.lastname@example.org
Copyright 2004, Roy G. Soto, M.D.