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
- Sedation, Pain and Delirium ScalesPADIS Guideline Key Points: Propofol or dexmedetomidine over benzodiazepines (2018). 2025: dexmedetomidine over propofol in ventilated adults if light sedation or less delirium is the priority. Dexmedetomidine is not for deep sedation; consider another agent if bradycardia risk is high.
- Mental Health: Meds and CommunicationAlcohol withdrawal: risk, dosing strategy and resistance: Resistance has no agreed definition; studies use more than 40–50 mg IV diazepam in 1 h or 200 mg in 4 h (ASAM 2020). One 10 mg/kg IV phenobarbital dose added to a lorazepam protocol cut ED patients’ ICU admissions from 25% to 8% (Rosenson 2013, n = 102); ASAM keeps parenteral phenobarbital to closely monitored settings. Propofol suits patie
- After Cardiac SurgerySternal wound, mobility and ERAS Cardiac: Early ambulation and upper-extremity exercise within comfort are safe and speed recovery (ERAS/STS 2024), the basis for Keep Your Move in the Tube. ERAS Cardiac 2019 also recommends goal-directed fluid therapy and tranexamic or aminocaproic acid (Class I), chemical VTE prophylaxis once hemostasis is secure, usually from day 1 (IIa), and opioid-sparing anal
- 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 Sedation, Pain and Delirium Scales questions free123 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 the order, the bag label, your pump library and your institution's protocol.