In this post I link to and excerpt from EMCrit 283 – Dexmedetomidine (Precedex) – You’d have to be Delirious Not to Use It October 16, 2020 by Dr Scott Weingart*.
*Scott Weingart. EMCrit 283 – Dexmedetomidine (Precedex) – You’d have to be Delirious Not to Use It. EMCrit Blog. Published on October 16, 2020. Accessed on October 19th 2020. Available at [https://emcrit.org/emcrit/dexmedetomidine/ ].
Dr. Weingart writes in his introduction:
So this episode addresses a big gap in the EMCrit content, namely a discussion of the myriad uses of dexmedetomine. This is one of the primary agents I use for post-intubation sedation (PAD), but also for things like NIPPV sedation and procedural sedation.
When you’ve finished reviewing the podcast and show notes, be sure to read all of the thoughtful readers questions and comments at the bottom of the show notes. The comments are an important part of the learning experience.
Here is the podcast:
And here are Dr. Weingart’s show notes:
Upsides of Dexmedetomine (Precedex)
- No respiratory depression
- Opioid sparing/analgesic effect
- Preserves Sleep Architecture
- Sympatholysis
- May be delirium-protective
- May be more hemodynamically stable than propofol
- Good for neurocritical care
Downsides of Dexmedetomidine
- Bradycardia
- Hypotension (especially when the pt is volume depleted)
Cost(much less of an issue now that it is generic)- Diuretic effect
- Slow onset
- Constipation
Useful for…
- Post-intubation sedation
- NIPPV sedation
- Procedural sedation
- Add-on to propofol
Other Stuff on EMCrit
- Podcast 115 – A New Paradigm for Post-Intubation Pain, Agitation, and Delirium (PAD)
- PulmCrit Wee- Extubating the agitated patient: dexmedetomidine vs. cowboy-style?
- Dexmedetomidine to facilitate noninvasive ventilation
Studies
- The Effect of Propofol and Dexmedetomidine Sedation on Norepinephrine Requirements in Septic Shock Patients (Critical Care Medicine: February 2019 – Volume 47 – Issue 2 – p e89–e95)
- https://www.ncbi.nlm.nih.gov/pubmed/21812509
- https://www.ncbi.nlm.nih.gov/pubmed/27035758
