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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.

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

Now on to the Podcast...