Dexmedetomidine (Precedex)

Trade names Precedex

Induces sedation while it preserves a degree of arousability among patients in the ICU, resulting in a shorter time to extubation, and increased number of days free from coma or delirium, reduced incidence of agitated delirium, prevention of delirium, and lower mortality than other agents administered in similar circumstances.

It is an alpha2 receptor agonist, that has anti-inflammatory and bacterial clearance properties that are superior to those of gamma aminobutyric acid (GABA ) agonists such as benzodiazepines and propofol.
Is associated with lower incidence of subsequent infections and includes lower 28 day mortality results, that are more pronounced in patients with sepsis.
It reduces neuron or apopptosis and promotes biometric sleep.

Pregnancy category C (Risk not ruled out)

As an intravenous infusion.

Protein binding 94%.

Near complete hepatic metabolism to inactive metabolites.

Biological half-life 2 hours.

Excretion Urinary

Anxiety reducing, sedative, and pain medication has ability to provide sedation without risk of respiratory depression.

Similar to clonidine, it is an agonist of α2-adrenergic receptors in certain parts of the brain.

Most often used in the intensive care setting for light to moderate sedation, and is not recommended for long term deep sedation.

Has analgesic properties in addition to its role as a hypnotic, but is opioid sparing, and is therefore not associated with significant respiratory depression.

Suggested for sedation in mechanically ventilated adults may reduce time to extubation and ICU stay.

Because patients are rousable and cooperative, and are able to actively cooperate with various procedures.

May be associated with less delirium than other sedatives, and associated with less neurocognitive dysfunction.

Associated with lower ICU costs, due to a shorter time to extubation.

Can also be used for procedural sedation, such as during colonoscopy.

It can be used as an adjunct with other sedatives like benzodiazepines, opioids, and propofol to enhance sedation and help maintain hemodynamic stability by decreasing the requirement of other sedatives.

Is also used for procedural sedation in children.

May be useful for the treatment of the negative cardiovascular effects of acute amphetamines and cocaine intoxication and overdose.

Intravenous infusion is commonly initiated with a loading dose followed by a maintenance infusion.

Associated with individual variability in its hemodynamic effects, as well as the sedative effects of this drug.

No absolute contraindications to its use.

Common side effects include: hypotension and bradycardia.

Has a biphasic effect on blood pressure with decreased blood pressure observed at lower concentrations and elevated blood pressure at higher concentrations.

When given rapidly by IV it may been associated with slow heart rate and hypotension) due to peripheral α2-receptor stimulation.

May enhance the effects of other sedatives and anesthetics, and may enhance effect of similar drugs when coadministered lowering heart rate and blood pressure.

It is a highly selective α2-adrenergic agonist and is able to achieve its effects without causing respiratory depression.

It induces sedation by decreasing activity of noradrenergic neurons in the locus ceruleus in the brain stem.

It increases the activity of inhibitory gamma-aminobutyric acid neurons in the ventrolateral preoptic nucleus.

Its sedation mimics natural sleep.

Provides less amnesia than benzodiazepines.

Has analgesic effects at the spinal cord level and can be used as an adjunct medication to help decrease the opioid requirements of people in pain while still providing similar analgesia.

Has a rapid distribution half-life of approximately 6 minutes and a terminal elimination half-life of approximately 2 hours.

Plasma protein binding of to albumin is approximately 94%.

Metabolized by the liver via glucuronidation and cytochrome P450, implying it should be used with caution in people with liver disease

The majority of metabolized drug is excreted in the urine at about 95%.

A short term sedative and analgesic for critically ill or injured people on mechanical ventilation in the intensive care unit (ICU).

Its indications include nonintubated people requiring sedation for surgical or non-surgical procedures, such as colonoscopy.

An alpha2-agonist.

A sedative with high alpha2-adrenoreceptor affinity and action in the locus ceruleus.

Reduces incidence of coma and delirium when compared to lorazepam.

Reduces duration of mechanical ventilation compared to profolol or midazolam.

Associated with earlier extubation, reduced delirium when compared to midazolam in ICU patients (Rikker RR.

A sedative medication used by intensive care units and anesthetists.

Has the ability to provide sedation without causing respiratory depression.

An agonist of α2-adrenergic receptors in certain parts of the brain,

An attractive treatment for patients with agitated delirium in the ICU because it induces a calm yet arousable state with preserved respiratory drive, allowing it to be continued after extubation.

Has a protein binding of 94%, near complete hepatic metabolism to inactive metabolites.

Urnary excretion.

Indicatedb for sedation of critically ill or injured patients in an intensive care unit setting.

Its indication expanded to include nonintubated patient requiring sedation for surgery or short-term procedures.

Used as an adjunct for sedation and general anesthesia, and for invasive medical procedures, such as colonoscopy.

There are no absolute contraindications to its use,

Usefulness limited in that it cannot be bolused due to concerns about peripheral α2-receptor stimulation with resulting hypertension and bradycardia.

Similar effectiveness as midazolam for sedation, but shortened the time to extubation, less delirium, tachycardia and hypotension, but more bradycardia.

A superior agent to lorazepam for ventilated patients in the intensive care unit.

Has sedative, analgesic, sympatholytic, and anxiolytic effects that may blunt cardiovascular responses in the perioperative period.

It can reduce the requirements for anesthetics, sedatives and analgesics without causing respiratory depression.

May be useful for the treatment of adverse cardiovascular effects of acute cocaine intoxication and overdose.

May be used for pain, agitation or delirium at the end of life.

Intravenous infusion is usually initiated with a 1 mcg/kg loading dose, administered over 10 minutes, followed by a maintenance infusion of 0.2–1.0 mcg/kg/hour, and the dose must be adjusted to achieve the desired clinical effect.

Among patients with agitated delirium receiving mechanical ventilation in the ICU, this drug added to standard care compared with standard care results in more ventilated free hours at seven days.

Among mechanically ventilated adults with sepsis being treated with light sedation outcomes in patients who received dexmedetomidine did not differ from outcomes in those who receive propofol (HughesCg).

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