May FY22

[kristenhorsman]

This month's journal article is presented by Jess Hadley. She chose an article titled "α2-Adrenergic Receptor Agonist, an Attractive but Underused ERAS Component in Improving Fast-Track Recovery and Surgical Outcomes." The article discusses how clonidine and dexmedetomidine, α2-adrenergic receptor agonists, can greatly enhance various ERAS components owing to their unique pharmacologic properties: antinociception, anxiolysis, anti-inflammation, and renal protection.


Please follow this link to the article and answer the following two questions: 

1. How are you using Dexmedetomidine in your current practice?

2. Do you think that Dexmedetomidine would be a helpful addition to our current ERAS protocols?

[Katya]

1. I use Dexmedetomidine a lot in my practice especially for outpatient procedures GI or GU with MAC. Also I use it for endoscopy cases, I give very small amount on the way to procedure room and found that even 4-6 mcg of Dexmedetomidine can reduce in half use of propofol.
2.I think Dexmedetomidine is excellent adjunct to ERAS cases.

[KELS]

1.)I don't tend to use Dexmedetomidine in my proctice

2.) I do think that Dexedetomide would be a helpful addition to our current ERAS protocols

[BelindaG]

1. I use Dexmedetomidine more recently as a bolus adjunct for EGDs and other stimulating sedation procedures or at the beginning or end of bigger cases for a smoother wake up.

2. I think we will see it added to our newer ERAS protocols!

[Amy Swank]

1. Yes, I use Dexmedetomidine in the outpatient setting, like that it is useful with the OSA patient. Need to be careful with the adverse effects of bradycardia and hypotension and avoid in those patients where those side effects would be dangerous. Definitely, best if given pre-op, even before leaving the pre-op area. I prefer a bolus up front, helping decrease the Propofol need.

2. I think it would be useful in the ERAS protocols with the correct patient.

[Anne McNulty CRNA]

(1) I use Dexmedetomidine in Mac cases to reduce the amount of narcotic and to keep patients with OSA comfortable. I have used it safely in small doses for the elderly in MAc cases. (2) I think infusions in era cases would be beneficial for Patients with OSA , PTSD and emergent delirium. I feel this drug is underused at JHU

[aileenm4]

1. I use Dex a lot in peds, we use it to prevent or lessen emergence delirium and I agree using a small amount of Dex in GI cases reduces the amount of Propofol
2. excellent idea for ERAS cases

[Jennifer Hannon]

1) I use Dexmedetomidine a lot in my practice especially for anticipated crazy wakeups in trauma or younger all day long patients. I give small increments and build up to 1-2mcg/kg.

2) I think Dexmedetomidine is wonderful for ERAS cases.

[kelseyleonard]

1. I use Dexmedetomidine frequently in my practice. It is useful as a primary agent in MAC cases that require only minimal to moderate sedation. When added with propofol it is great for deep sedation and preserves respiratory function. I also find it useful when bolused on emergence to reduce emergence delirium.

2. I think Dexmedetomidine would be great for ERAS patients and it underused across all JHH ORs.

[Dahlia Rouchon]

1. yes, I use precedex in my current practice. It is a great adjunct in small aliquots of 4mcg at a time to desired effect for Wilmer, Endoscopy, or TEE procedures to blunt stimulation and augment sedation. It is helpful for ETOH abusing patients as an adjunct to spine procedures to assist with emergence delirium. it is also helpful for difficult airway situations as bolus or aliquot boluses where the concern of loss of airway with propofol, versed/fentanyl is not desired but anxiety is present to assist with calming the patient for cannot intubate/cannot ventilate scenario is expected.
2. precede is wonderful in low doses for eras but must be used with caution for the elderly, CKD, or for long procedures as it can lead to prolonged hypotension/bradycardia