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
* May be delirium-protective
* May be more hemodynamically stable than propofol
* Good for neurocritical care
Downsides of Dexmedetomidine
* Hypotension (especially when the pt is volume depleted)
* Cost (much less of an issue now that it is generic)
* Diuretic effect
* Slow onset
* 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
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)
Now on to the Podcast...