Dexmedetomidine
Indications
Dexmedetomidine is used for:
ICU Sedation, Fiberoptic Intubation, Procedural Sedation
Adult Dose
ICU Sedation
Load: 1 mcg/kg IV over 10 minutes
Maintenance 0.2-1.4 mcg/kg/hr IV
Titrate less frequently than q30min to prevent hypotension
Fiberoptic Intubation
Load: 1 mcg/kg IV over 10 minutes
Maintenance 0.7 mcg/kg/hr IV
Procedural Sedation
Load: 1 mcg/kg IV over 10 minutes
Maintenance 0.6 mcg/kg/hr IV titrate to effect (usually 0.2-1 mcg/kg/hr)
Titrate less frequently than q30min to prevent hypotension
Hepatic Impairment
Dose reduction may be required
Child Dose
Safety and efficacy not established
Renal Dose
Renal Impairment
Dose reduction may be required
Administration
IV Preparation
Dilute in NS
IV Administration
Infuse loading dose over 10 min
Contra Indications
2nd or 3rd degree AV block (unless paced), uncontrolled hypotension, acute cerebrovascular disorders.
Precautions
Significant CV dysfunction, advanced heart block &/or severe ventricular dysfunction, hypovolemia, DM, chronic HTN. Renal & hepatic impairment. Do not inj by bolus or rapid IV. Do not administer for >24 hr.
Pregnancy & lactation. Elderly. Childn <18 yr.
Lactation: Excretion in milk unknown; use with caution
Pregnancy-Lactation
Interactions
Enhanced pharmacologic effects of anaesth, sedatives, hypnotics, opiate agonists, other vasodilators or drugs that have negative chronotropic effects (e.g. cardiac glycosides).
Adverse Effects
Side effects of Dexmedetomidine :
>10%
Hypotension (28%)
1-10%
AFib.Anemia,Bradycardia,Fever,Pleural effusion,Leukocytosis,Pulmonary edema
Mechanism of Action
Centrally acting alpha2-adrenoceptor agonist that has sedative and anesthetic properties possibly by activating G-proteins in the brainstem, which results in the inhibition of norepinephrine release.