Post-Intubation Sedation

Precedex

If transitioning from propofol, start low – o.5 mcg/kg/hr

If starting as primary agent, start higher eg – 1 mcg/kg/hr

Titrate 0.1 mcg/kg/hr q 20-30 min

Max dose probably around 1.6 mcg/kg/hr

Can also do an initial loading infusion – titrate q 10 min until HR drops then turn off for 30-60 min and then re-start at half of that last dose as their long acting infusion dose

Use analgesia in addition e.g. dilaudid or pain dose ketamine at 10-20 mg/hr

Upsides of Dexmedetomine (Precedex)

  1. No respiratory depression
  2. Opioid sparing/analgesic effect
  3. Preserves Sleep Architecture
  4. Sympatholysis
  5. May be delirium-protective
  6. May be more hemodynamically stable than propofol
  7. Good for neurocritical care

Downsides of Dexmedetomidine

  1. Bradycardia
  2. Hypotension (especially when the pt is volume depleted)
  3. Cost (much less of an issue now that it is generic)
  4. Diuretic effect
  5. Slow onset
  6. Constipation

Useful for…

  1. Post-intubation sedation
  2. NIPPV sedation
  3. Procedural sedation
  4. Add-on to propofol