What are your thoughts on using Precedex for ambulatory IV sedations? Is your program utilizing this medication? If so, what is your protocol for use (Other drugs being used, etc.)? Noticed any effects on the vitals after administration?
Thanks.
-dylan
Hi Dylan
Some personal thoughts from our institution in Taiwan.
When Precedex (Dexmedetomidine) being used in the ambulatory setting like dental implantation under IV sedation, our anesthesiologist would prefer combination use of Propofol and Dormicum, Precedex might be beneficial with regard to respiratory depression. But in our experiences we’ve still seen some cases of bradycardia when using Precedex. So it is prudent to utilize these drugs.
By the way, in scenarios like treating pediatric patients, we would give a mixture shot of * Midazolam 0.15mg/kg + Ketamine 1.5mg/kg intramuscularly, then IV sedate in the usual manner.
As the cost of Precedex is still relatively high, considering cost-effective performance, this is not commonly used by now.
I would say it’s a good question
Hope to share some thoughts with u, Dylan
Best,
Aaron
Great answer and thanks for sharing- it’s nice to hear a perspective from Taiwan on this forum. In the US, we’ve started using Precedex in the ambulatory setting as it is now relatively cost effective and provides additional sedation. I’ve seen it used more commonly in longer procedures and for patients that are more refractory to our standard drugs (daily cannabis users, alcoholics, etc.) Otherwise our standard agents are generally propofol, ketamine, fentanyl, and midazolam. Agree with your comment about bradycardia, however, in my experience it tends to be fairly transient.
Great choice for full arch cases!
Great question! Here’s a link to Dr. Dalen Mill, MD Anesthesiologist interview on Every Day Oral Surgery.