Dexmedetomidine

Question 1

What is the brand/trade name for dexmedetomidine?

Answer 1

• Precedex

_{UpToDate - Dexmedetomidine: Drug Information}

Question 2

What is the pharmacologic category/class of dexmedetomidine?

Answer 2

• Sedative
• Alpha-2 adrenergic agonist

_{UpToDate - Dexmedetomidine: Drug Information}

Question 3

What is the mechanism of action of dexmedetomidine?

Answer 3

Brainstem: decreased alertness
alpha 2 agonism

• ↓ calcium mediated release of norepinephrine
• postsynaptic potassium efflux & hyperpolarization

Spinal Cord: analgesia
alpha-2 agonism

• ↓ calcium mediated release of glutamate
• postsynaptic potassium efflux → neuronal hyperpolarization

_{Nagelhout (7th), pp. 115, 1300
UpToDate - Dexmedetomidine: Drug Information}

Question 4

Some providers opt for a loading dose/bolus of dexmedetomidine prior to infusion - what is the dosing regimen for this?

Answer 4

• 0.5-1 mcg/kg bolus over 20-30 minutes

Some cite bolus over 10 mins, but greater chance of HoTN/bradycardia

_{Nagelhout (7th), p. 115
UpToDate - Dexmedetomidine: Drug Information}

Question 5

Adult IV push dosing of Dexmedetomidine

Answer 5

2-10 mcg

Steal 200 mcg (2mL) inject in 100 mL NaCL bag, withdraw 10mL for 20 mcg (2mcg/mL)

Some cite bolus over 10 mins, but greater chance of HoTN/bradycardia

_{Nagelhout (7th), p. 115
UpToDate - Dexmedetomidine: Drug Information}

Question 6

What is the dosing range of dexmedetomidine infusions for procedural sedation and general anesthesia?

Answer 6

• 0.1-1 mcg/kg/hour titrated to desired effect
• Alternatively, small intermittent boluses of 2-8 mcg can be utilized

Often diluted to concentration of 4 mcg/mL - do some maths for bolus

_{Nagelhout (7th), p. 115
Vargo, people on facebook, google, ya know - street cred
UpToDate - Dexmedetomidine: Drug Information}

Question 7

What is the onset of action for dexmedetomidine?

Answer 7

• ~5 minutes, peak effects in ~15 minutes

_{Nagelhout (7th), p. 116
UpToDate - Dexmedetomidine: Drug Information}

Question 8

What is the duration of action for dexmedetomidine?

Answer 8

• 30-60 minutes

DOSE/INFUSION DEPENDENT

_{UpToDate - Dexmedetomidine: Drug Information}

Question 9

True or False:

Dexmedetomidine, like other sedatives/hypnotics, has a significant effect on ventilation and airway reflexes

Answer 9

• False - dexmedetomidine maintains respirations and airway reflexes

_{Nagelhout (7th), p. 116}