Dr. Soto's Pearls!

Dexmedetomidine
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 other sedatives.
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 20 minutes

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 and bradycardia

IF you gave a proper load prior to stimulation, you can avoid other sedatives, especially if doing a MAC

Thanks to Dr. John Basile for the inspiration!