Sedation, analgesia and paralysis
Dexmedetomidine (Precedex) drip
Precedex
Dosing
| Start | 0.2–0.7 mcg/kg/h; the loading dose is often skipped |
|---|---|
| Titrate | By 0.1–0.2 mcg/kg/h about every 30 minutes |
| Maximum | 0.7 mcg/kg/h on the label; studies used up to 1.5 |
| Common bags | 400 mcg in 100 mL (4 mcg/mL); 200 mcg in 50 mL (4 mcg/mL) |
| Dose units | mcg/kg/h |
Line and administration
- Peripheral or central
Watch for
- Bradycardia and hypotension
- Little respiratory depression; not enough for deep sedation
Dexmedetomidine: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Airway and RSIConfirmation and the first hour after intubation: Rocuronium lasts about an hour; etomidate wears off in minutes. Start analgesia (usually fentanyl) and then sedation within minutes of confirmation; ED-AWARENESS (Pappal, Ann Emerg Med 2021) linked awareness with paralysis to delayed sedation after long-acting paralytics. Once the paralytic wears off, PADIS 2018 favors light sedation (RASS −2 to +1
- Obstetric EmergenciesDrugs in pregnancy in the ICU: Propofol, opioids, dexmedetomidine: Yes: Neonatal depression near delivery
- Rhythm GallerySinus rhythms and sinus node dysfunction: Exams call under 60/min sinus bradycardia; the 2018 ACC/AHA/HRS guideline and AHA 2025 use under 50, and symptoms decide treatment. Bedside causes: vagal surges (suctioning, vomiting, straining), hypoxia, hypothermia, hypothyroidism, inferior MI, hyperkalemia, raised ICP and drugs (beta-blockers, diltiazem, digoxin, amiodarone, dexmedetomidine, propofol).
Practice Airway and RSI questions free196 exam-style questions with rationales on the topic where dexmedetomidine comes up most. No account or download needed.
Other sedation, analgesia and paralysis
- Propofol
- Midazolam
- Fentanyl
- Cisatracurium
- Ketamine
- Hydromorphone
- Rocuronium
- Vecuronium
- Pentobarbital
- Remifentanil
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.