Dexmedetomidine

General

Adult Dosing

ICU Sedation

  • 1 mcg/kg over 10 minutes
    • Followed by 0.2 to 0.7 mcg/kg/hr

Procedural Sedation

  • 1 mcg/kg over 10 minutes
    • Followed by 0.6 mcg/hr titrated to effect (generally 0.2 to 1 mcg/kg/hr)

Pediatric Dosing

Post-Intubation Sedation

  • Do not bolus
  • Start at 0.2-0.4 mcg/kg/hour and titrate to a max of 1.4 mcg/kg/hour
    • Recommended to start at 0.4 mcg/kg/hour for agitated patients
  • Make changes every 15-20 minutes if not desired affect or sooner if patient is agitated
  • May use with spot does of other medications like fentanyl and versed.
    • If on fentanyl or versed drip already should be able to titrate the dose down.

Special Populations

  • Pregnancy Rating: C
  • Lactation: Unknown if excreted in milk. Exercise caution
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

  • Hypotension
  • Bradycardia
  • Apnea

Common

  • Hypotension
  • Bradycardia
  • Dry mouth

Pharmacology

  • Half-life: 2 hours
  • Metabolism: Hepatic
  • Excretion: Renal
  • Mechanism of Action: Selective α-2 agonist

Comments

  • Provides analgesia and anesthesia
  • Hemodynamically neutral medication
  • Provides sedation with maintenance of arousability, airway protection

See Also

References