Category Archives: Precedex

Anesthesia and Pain Management for the Surgeon – Highlights – Notes

Anesthesia and Pain Management

  • PRIS – Propofol Infusion Syndrome – can be fatal.  Cardiac failure, rhabdomyolysis, and a severe metabolic acidosis.
  • Adrenal insufficiency secondary from Etomidate (induction agent) administration may be a cause of hypotension in the post op surgical patient.
  • Dexmedetomidine  (Precedex)has  analgesic properties, sedation, stable respiratory rates, predictable cardiovascular responses.
  • Ativan should not be discountinued abruptly after long term use in the ICU patient.
  • Heterotopic calcification and myopathies are complications of long term chemical paralysis – thus chemical paralysis for ventilated patients are now not as popular.
  • Pulse oximetry readings not as accurate in patients with smoke inhalation.
  • Colorimetric CO2 indicator – stomach intubation can still change the color, initially.
  • CNS and Cardiotoxity related to local anesthetic use – a concern when intercostal nerve blocks used for multiple rib fractures.  Lidocaine info
  • Place/Pull epidural catheters, won’t do unless lovenox/heparin sq held for 24 h.
  • As doses and duration of Metaclopramide (Reglan – Dopaminergic blocker) increases – neurologic side effects (movement disorders) also increases.
  • Oral to IV morphine is 3:1
  • Main use for LMA is for short cases in operating room.  There are concerns for vomiting and aspiration.


Precedex does not cause respiratory depression

Dexmedetomidine (Precedex)


  • Sedation without respiratory depression
  • Ideal for use in the Intensive Care Unit.
  • Can be used for managing extubations.
  • No absolute contraindications
  • Compared to Versed (Midazolam), Precedex is associated with less delirium, tachycardia, and hypotension, but had more bradycardia
  • Agonist of alpha 2 adrenergic receptors in the brain
  • FDA reports that infusions greater than 24 hours in duration include ARDS, respiratory failure, and agitation