Dexmedetomidine (Precedex) - Critical Care Medications

[@ICUAdvantage]

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[@paigeaspinwall5835]

I am excited! I completed the CCRN Academy review & passed. I enjoy ICU Advantage and really excited for you to share this with us! Can't wait to get started!

[@megancummings7546]

This is so exciting!!! Congratulations Eddie!

[@ICUAdvantage]

@@paigeaspinwall5835 Way to go Paige!! Excited to officially open things up and be able to provide CEs for all this education. As always, thank you so much for all your support! Really glad to know you will be a part of this and are excited for it.

[@ICUAdvantage]

@@megancummings7546 Thanks so much Megan! Very excited for this.

[@Sound0ne]

I just completed a study with Yale research unit. As a fentanyl addict, Dexmedetomidine along with low tapering doses of methadone got me through a 7 day withdrawal period. Now that I’m home, symptoms are weak enough to deal with using ibuprofen and CBD. Excited to see where this drug takes us in the OUD crisis

[@jordanschmidt9772]

I once had a patient on this. On 0.4 mcg/kg/min, he was snowed. But on 0.3 he was wide awake and agitated. Such a strange medication. Either works wonderfully or is just frustrating, in practice. Great video!

[@ICUAdvantage]

Haha, exactly! Exactly why I have a love hate relationship with it. When its good its great, otherwise, I feel like Im better off infusing saline.

[@kimberlyelmer9472]

We have a frequent return LVAD patient who loves the recreational drugs outside the hospital. She's wild and awake maxed on fentanyl and prop, but add a bit of dex and she's comatose. So weird.

[@jaecaflanagan-simpson8270]

Did you try .35?! Lol j/k

[@anahit6645]

😂

[@Aligatortubtub]

You are an incredible instructor. I learn so much from every single video you post and truly appreciate all your hard work.

[@ICUAdvantage]

Wow, thank you so much for this Ali! Glad you have enjoyed the videos and found them helpful!

[@happynurse8706]

I've used this medication many times works excellent in the situations I've needed very good for detox patients

[@ICUAdvantage]

Yeah I've found when it works, it works great.

[@bianca_1005]

Dexdor! (Here in Italy it's the brand name) When I began working in cardio ICU coming from a big ward full of patients with delirium this drug was a MIRACLE to me... No more running after granny who's ripping off her CVC/catheter, you name it...while another one tries to ace the diving championship jumping head first from the bed and another two gramps are escaping 😂 The most frequent side effect we observe is bradycardia, followed by hypotension. We use it in agitated patients whose devices do not have to be tampered with (e.g. Swan Ganz, arterial lines, or if they need a CPAP helmet but tear it off). Or in case of small procedures. As you say, the dosing and rate is decided by the facility. We have a protocol in place. Thank you, clear and concise as always 🔝

[@ICUAdvantage]

Haha oh the stories we come across in healthcare! People have NO idea! Thanks so much for sharing Bianca. I've had mixed success with it, but have found at facilities that allow for larger doses, that it can be more effective. Sometimes, some people just don't respond. Agreed that Brady and hypotension are the most common and often the biggest reason to stop using it.

[@kristinamidolo7681]

Absolutely loving your video's - so helpful to a new ICU nurse

[@phil.curious]

Thank you so much for the videos on the different drugs. Just started to work with Milrinon and Dex. as soon as your videos came out. Perfect timing. Highly appreciate it!

[@ICUAdvantage]

Haha awesome! I love it when the timing works out like this Phil!

[@Blinn2330]

Here since what feels like day 1 and you always produce excellent content. Keep it up. Big fan of Precedex!

[@ICUAdvantage]

Right on! Thanks for the support all this time. Glad you enjoyed it!

[@giogarcia4053]

Another great video! Precedex is a fantastic med when it works, we use it often on our post op CABG patient until we can extubate or even with low tolerance to bipap because it’s very useful for anxious intubated patients most of the time and doesn’t have too much of a effect on our hemodynamics most of the time. Although some patients have a really good tolerance to it and require more sedation/pain relief.

[@ICUAdvantage]

Whole heartedly agree! When it works, it works magic. And that fact that it doesn't cause respiratory depression makes it possible to use in so many situations we wouldn't normally be able to. Thanks so much for your support!

[@sharonmason8985]

We use this med for sedation in kids who are I &V and used for several days along side with fentanyl

[@ICUAdvantage]

Whats I&V?

[@AaaAaa-hb9be]

Very common drug used in veterinary medicine! We also routinely use an antidote, atipamezole.

[@shanepis]

My preceptor and myself (I am new to practice nurse this past December) got floated from ICU stepdown to ICU and we had a pt on this drip while alert on HFNC. It kept them calm so they would put their O2 demand up. It went well. Thank you as always for teaching this stuff. I am hoping in some time to move from stepdown to ICU.

[@brycekallenbach8042]

You will find that it works or it doesn't. When it does work, it is mostly effective for 24hrs. Even then, bradycardia is common in my experience.

[@nygeek6471]

It’s very hit or miss. It’s also prone to nasty hemodynamic effects. It can also decrease RBC count. Definitely not to be used outside of an ICU setting

[@ICUAdvantage]

Agreed with others. Very love hate relationship. When it works, its great and perfect for what is needed. Other times, no matter how high you go, it seems to be no better than saline. Glad to hear it helped in your situation and hope to hear from you again when you get into the ICU!

[@nygeek6471]

@@ICUAdvantage totally agree with the sometimes it feels like it’s just saline, other times it works. Sometimes your patients hemoglobin is dropping when they’re on it for too long. Other times they go into arrhythmias. Overall I’m not a fan of precedex at high doses for long periods of time. I feel like I can get more from low dose prop with less side effects

[@ICUAdvantage]

@@nygeek6471 Yeah if intubated I will 100% take prop 99/100 times.

[@alecfairfield2745]

In the PICU we love Precedex

[@ICUAdvantage]

It really is great when it works, and doesn't cause those issues :)

[@justin.fairchild]

We use this in most all of our post op heart patients when they come up from surgery. It works well in conjunction with pain control.

[@ICUAdvantage]

Agreed! We typically would just use analgesics in recovery when possible, but if some sedation or anxiety control was needed, this was typically our goto.

[@ChaseWatkins.]

Have used intranasal for pediatric patients in the ED, works well.

[@ICUAdvantage]

Nice. Hadn't heard of that way. Thanks for sharing that Chase!

[@kaseydunn8694]

Wouldn’t benzos and propofol potentiate/activate GABA receptors, not inhibit it?

[@jongjincoleman4386]

Great learning ICU learning tool!!!

[@ingothitrust5248]

There is a very odd and specific cohort of patients for whom this medication works reasonably well for. Just from experience and observation, 9/10 this med doesn't do diddly squat.

[@shanekaervin6733]

Thank you for creating this video! It is very helpful

[@ICUAdvantage]

Great to hear this Shaneka! Glad you liked it.

[@camerynjewell9299]

Hi Eddie, would you say that hypocalcemia/magnesia is a common side effect from Precedex?

[@rezgatchi726]

Thank you very much😭 I just started working in Cardiac Care ICU looking after patients post MVR, CABG. My patient was on this drip together with Noreadrenaline, Dobutamine and Propofol. Thank you your videos are indeed very helpful. It lessens my anxiety and boosts my confidence. God bless you!💜💜💜

[@ICUAdvantage]

Hey Rez! Thanks so much for taking the time to drop a comment. ❤ Really glad to hear the videos are helpful for you and help to take the edge off. I know it can be stressful at times so truly happy to know they are helping you out.

[@rezgatchi726]

@@ICUAdvantage im picking up extra shifts and saving up so I can purchase ICU advantage Academy. I want to take this skill in a new level. My goal is to be CCRN certified. 🙏🏻✨

[@ICUAdvantage]

@@rezgatchi726 You got this Rez! You definately are doing the right things by growing your knowledge base and making you a better practitioner.

[@MegaMrskatie]

This was helpful. Thank you

[@beckyp8914]

I have found that this drug always works. I’ve been using it for years on my patients in the ICU and has been a life savor for my patients and my sanity. I can’t think of a time where it has totally failed me. ❤️ Precedex… thanks for informative video.

[@Ingitadhikary]

can we have a detail vedios on hypo or hyper natremia , kalemia etc

[@08MordSith]

Can you explain more about it's use in alcohol withdrawal?

[@ICUAdvantage]

GABA receptors are involved as a binding site for ethanol. In the same ways that benzos bind to GABA receptors to produce inhibitory action, Dex also influences the inhibition of GABA neurons, helping to prevent withdrawal symptoms and DTs. That along with the sedation without respiratory depression can be helpful in managing severe alcohol withdrawal that normally has required over sedation with benzos, and thus a prolonged ICU stay.

[@08MordSith]

@@ICUAdvantage precedex does not hit GABA. We're having challenges with sedating etoh patients with precedex without hitting GABA causing seizures.

[@ICUAdvantage]

@@08MordSith Correct about not hitting GABA. It effects upstream with same inhibition of GABA neurons without direct binding like beznos and prop. My experience tho has been with it as an adjunct with typical benzo treatment. Helps prevent high dose benzo drips and can help with reduced dosing of Bezos based on CIWA.

[@08MordSith]

@@ICUAdvantage respectfully disagree, unless they have GABA coverage via benzos or phenobarbital, precedex should not be used

[@ICUAdvantage]

@@08MordSith I think there’s a misunderstanding. That how I’ve known it used; as an adjunct with benzos. Not used alone.

[@AT-yj8gl]

Eddie can you PLEASE make a series for Med Surg nurses wanting to transition to critical care? There's such a learning curve and barely any of it was covered in school. If you make it and choose to put it behind a reasonably priced pay wall, I'll pay!

[@ICUAdvantage]

Hey there! So I do have plans eventually to do like an ICU Bootcamp type of course, but honestly with my time commitments right now, probably won't be any time soon for that.

[@AT-yj8gl]

@ICUAdvantage ofc I get that sir. ill be on the lookout when you do drop if I haven't transitioned by then. meanwhile do you have any other creators you recommend on KZbin to help with that?

[@ICUAdvantage]

@@AT-yj8gl I can't think of anyone that has any content specifically covering anything like that.

[@agentpaper1163]

Sometimes, I wanna take dexmed for myself 😵‍💫😵‍💫😵‍💫

[@chikazulu102]

For continuous sedation if you using propofol how many milligrams per kg in adults

[@allyu274]

Can precedex drop blood pressure less common than it does heart rate? The NP I worked with tried to tell me it doesn’t affect blood pressure, even though this patient is sensitive to sedation already.

[@skyfiraprimafilla9824]

Thank. You. ❤❤

[@zakilivoali2504]

Great stuff

[@MsDwayne67]

So because of the blocking of norepinephrine would that be one of the causations of hypotension? Sorry if it is a dumb question

[@MsDwayne67]

Our parameters are start at 0.2 mcg to max of 1.5 mcg

[@F1rst0raft]

I love precedex!

[@ICUAdvantage]

It is a good one! 😂 Life of Darnelle

[@stratoleft]

I need it for my cats.

[@carleebusardo2885]

Would it make sense to use precedex and Levophed (norepinephrine) at the same time?

[@jasminefrias6521]

Oh 100%, all the time. Levophed’s action on beta actually helps counteract the bradycardia that’s most commonly seen with precedex.

[@javierorozco4260]

Do you recommend the membership to any ED nurses or is this more for the ICU?

[@ICUAdvantage]

Yeah definitely helpful in the ED as well. Some topics may not apply, but most do. As for the Academy (I’m assuming that’s the membership you’re referring to) that basically has all the benefits of all KZbin/Patreon membership tiers, plus, most importantly, you’ll be able to get CEs for watching these video lessons I put together.

[@USA__WILL]

My favor ICU med ! Prop is a close second

[@ICUAdvantage]

It is a goodie! I will say I like my prop more tho 😉

[@nygeek6471]

@@ICUAdvantage I have to agree prop is much more consistent and reliable

[@nygeek6471]

3:46 don’t benzos and propofol activate, rather than inhibit GABA receptors? GABA agonists sedate. 4:53 isn’t the hypotension from the activation of alpha 2 receptors on peripheral vasculature like colonidine

[@ICUAdvantage]

So for the GABA section I definite said that weird. Basically what I was trying to state is that the impacted neurons would be inhibited. Which yes the activation and potentiation of GABA receptors increases inhibitory effects of GABA. As for the hypotensive/bradycardic effects of both Dex and Clonidine, it seems to be that both work in brain stem by inhibiting norepi release at neuronal junction preventing activation of sympathetic response thus vasoconstriction and bradycardia can result.

[@nygeek6471]

@@ICUAdvantage gotcha. I think the bradycardia is from norepinephrine inhibition to the vagus nerve, and alpha 2 agonism is from activation at peripheral vasculature (activating alpha 2 receptors vasodilators arteries.) Double checked and the second part is what I’m getting on UpToDate, the 1st part about the vagus nerve from an attending about why precedex causes bradycardia but clonidine causes tachycardia (no baroreceptor reflex with precedex like with clonidine)

[@ICUAdvantage]

@@nygeek6471 Interesting you mention about the vagus nerve. Looking around now specifically for that I do so a couple things talking about increasing vagal activity via Ach, but still most seem to point to the central inhibition of sympathetic activation as the primary driver of Brady/hypotension with a2 agonists. That is an interesting point about the reflexive tachycardia and I'll have to look into it more as to why we wouldn't still have potential for baroreceptor reflex with Dex.

[@nygeek6471]

@@ICUAdvantage thanks! Love the pharm/patho. P.s. ach is the parasympathetic signaling pathway in the CNS, it cascades from GABA like norepi cascades from glutamate. This is why anticholnerigcs increase heart rate via inhibiting the vagus nerve (and heart transplant patients don’t have vagal innervation hence why atropine won’t work in them)

[@caynofficial]

at my ICU we use 8mcg/ml concentration. however standard is the mixture with glucose which I dont really understand, can someone explain?!

[@ICUAdvantage]

Oh interesting. What is the total dose and volume in a bag?

[@caynofficial]

@@ICUAdvantage as far as I remember its 2000mcg at 250 glucose, we call it the BIG dexdor infusor^^ but honestly it works pretty well and we need less volume over the day which is benefitial to the patients in most cases.

[@michaelburatovich3199]

What’s the advantage of dexmedetomidine over midazolam for anxious patients?

[@ICUAdvantage]

So response will vary patient to patient, but big advantage is lack of respiratory depression

[@michaelburatovich3199]

@@ICUAdvantage plus midazolam has a serious hangover effect-it makes the patient drunk when they wake up.

[@ICUAdvantage]

@@michaelburatovich3199 For sure. I mean theres more advantages, especially with delirium and whatnot, but the resp depression I think is the biggest.

[@connorfolan7386]

Precedex is so weird, either puts them straight to sleep or does nothing at all

[@ICUAdvantage]

True story!

[@Jenn4rmblk]

I hate precedex. It’s completely useless in adults 😒