Dexmedetomidine

Aka: Dexmedetomidine, Precedex, Dexdor, Dexdomitor

1. Indications
   1. Post-Intubation Sedation and Analgesia
      1. Short-term sedation (<24 hours) in ICU patients on Mechanical Ventilation
      2. Tachyphylaxis occurs with use >24 hours
   2. Alcohol Withdrawal
   3. Peri-procedure sedation
2. Mechanism
   1. Selective central alpha-2-adrenergic agonist (similar to Clonidine) with sedative properties
   2. Brainstem G-Protein activation inhibits Norepinephrine release
      1. Decreases sympathetic tone and peripheral vascular resistance
3. Advantages
   1. Offers sedation while allowing patients to maintain their airway, maintain respirations and respond
   2. Generic
4. Pharmacokinetics
   1. Onset: 10 minutes
   2. Duration: 1-2 hours
   3. Renal and hepatic metabolism
5. Dosing
   1. Load: 1 mcg/kg in adults (0.5 to 1 mcg/kg in children) over 10 minutes, then
   2. Infusion: 0.2 to 0.7 mcg/kg/hour in adults (0.2 to 0.5 mcg in children)
      1. Titrate to desired level of sedation, modifying dose every 30 min to 0.2 to 1.5 mcg/kg/hour
      2. Decrease dosing in hepatic dysfunction and the elderly
   3. Reduce dose in over age 65 years or renal/hepatic Impairment
6. Adverse Effects
   1. Severe Bradycardia
   2. Hypotension
      1. Transient Hypertension may occur with rapid infusion
   3. Dry Mouth
7. References
   1. Fisher and Fisher (2018) Crit Dec Emerg Med 32(1): 24
   2. Kay (2015) Crit Dec Emerg Med 29(8): 11-17