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Post by Soo-Ok Kim on Sept 24, 2019 19:31:27 GMT -5
I used precedex mostly as an adjunct anesthesia for the cases as described with other posts, more frequently with pediatric patients. I used to use it as sole anesthesia with EP cases for devices implantation (PM or ICD) especially for morbidly obese patient with low dose of phenylnephring gtt during the procedure. However, when I found out pt tends to be more hypotensive with that and delayed discharge in PACU, I stopped using it.
I don't use them for EP cases for arrhythmia ablation since it can affect and slow down the conduction system.
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Post by Kristen Horsman on Sept 25, 2019 13:40:46 GMT -5
1. I have used Dexmedetomidine as an anesthesia adjunct for known difficult intubation and for a smooth wakeup in cases where bucking could be detrimental. It was not readily available until recently, so I am starting to try to incorporate it more.
2. The advantages are sedation, anxiolysis, analgesia, decreased sympathetic response, reduced shivering, and no respiratory depression in smaller doses. Therefore, it would be useful/indicated in any situation you would require these. The limitations are bradycardia and hypotension.
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Post by emedina1 on Sept 26, 2019 16:03:49 GMT -5
I have no experience using Percedex as a sole anesthetic , I had used it as an adjunct in Wilmer pediatric cases. I am very fond of it because my patients do not under go the post sevo delirium. Due to the limited usage of it, I have not seen the negative effect as in bradycardia or hypotension.
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Kristen Praesel Lang
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Post by Kristen Praesel Lang on Sept 27, 2019 15:13:53 GMT -5
1. Describe the use of Dexmedetomidine as an anesthesia adjunct versus sole anesthetic in different surgeries and patient populations. How do you incorporate it into your practice?
I have only used dexmedetomidine as an adjunct agent in my anesthesia practice. I have used it in pediatric cases (mainly T&A) to aid in a smooth emergence when I worked in pittsburgh. I have used it in adults at Hopkins in patient's with a history of emergence delirium, as well as in patients with chronic pain.
2. Discuss the advantages, indications, limitations, and precautions of Dexmedetomidine.
The main advantage of dexmedetomidine is that it provides sedative and analgesic effects without respiratory depression. As an adjunct anesthesia agent, it can reduce MAC, as well as narcotic requirements for anesthesia cases. Side effects like bradycardia and hypotension contraindicate the use of precedex in cardiac patients with cardiomyopathy and/or heart block. While hypotension and bradycardia are expected with precedex use, these side effects can be more pronounced in vulnerable populations including those with diabetes mellitus, hypertension, hypovolemia, and the elderly.
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Post by Catherine Lawry on Sept 29, 2019 19:47:36 GMT -5
1. Describe the use of Dexmedetomidine as an anesthesia adjunct versus sole anesthetic in different surgeries and patient populations. How do you incorporate it into your practice? I have mostly used dex as an adjunct to anesthesia or as part of a TIVA anesthetic. I used it a fair amount at my previous job mostly because it was available in most of our pyxis machines. I used dex for thyroid cases, bariatric procedures, tonsils and dental procedures in pediatrics, and in TIVA cases in neuro and breast cases. We would use dex in our EP lab for MAC cases for VT and SVT ablations. Our interventional cardiologists actually requested it! I found that dex helped ensure a smooth emergence in most instances. It helped reduce emergence delirium in the pediatric population. Dex helped cut down on opioid doses in the bariatric population which made it an attractive choice. I used it at JHH only once on a patient with chronic pain as a part of a TIVA. It worked well for that particular patient.
2. Discuss the advantages, indications, limitations, and precautions of Dexmedetomidine. The advantages of dex are many. It reduces catecholamines and myocardial O2 demand which is helpful in cases such as carotids. Some anesthetists used this for carotids at my previous job, but I did not because it seemed to prolong wake up. You have to turn it off or significantly decrease the dose early on in the case. I like dex because it seems to smooth emergence, cut down on opioid doses, decrease emergence delirium in kids, and it is helpful in awake intubations because the patients respiratory drive is not suppressed and they are comfortable. Limitations include patients with CV instability, bradycardia and hypotension. Dex should not be used in free flap cases due to peripheral vasoconstriction.
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