A Bedside Guide To Mechanical Ventilation by unknow

Author:unknow
Language: eng
Format: epub
Published: 2011-06-18T17:00:00+00:00

Dexmedetomidine (Precedex)

Mechanism of action - Selective alpha2-adrenoceptor agonist with anesthetic and sedative properties thought to be due to activation of G-proteins by apha2a-adrenoceptors in the brainstem resulting in inhibition of norepinephrine.

Dose-Initial: Loading infusion of 1 mcg/kg over 10 minutes followed by a maintenance infusion of 0.2-0.7 mcg/kg/hour; adjust rate to desired level of sedation; titration no more frequently than every 30 minutes may reduce the incidence of hypotension.

Pharmacokinetics-Onset: 5–10 minutes. Duration: 60–120 minutes. Metabolism: Hepatic via N-glucuronidation, N-methylation, and CYP2A6.

Pearls- Does not affect respiratory drive. Precedex is only FDA approved for 24 hour infusion duration. Hypotension occurs in 50% of patients and can be exacerbated by other anti-hypertensive medication. A difficult and expensive drug to use for sedation > 24 hours. Consider in patients who are difficult to wean secondary to agitation.

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