Tuesday February 12, 2008
Precedex® (dextromedetomidine) - better?

Precedex is now a commonly used drip in ICUs due to its simultaneous anxiolytic, anesthetic, hypnotic, and analgesic properties and moreover it does not depress respiration. But still cost is a major concern to prescribe this medicine.

A recent study published in JAMA 1 found Dexmedetomidine superior to Lorazepam for sedation. Dexmedetomidine induces sedation via different central nervous system receptors than the benzodiazepine drugs and may lower the risk of acute brain dysfunction. Interestingly, there was no difference in cost.

Design: It was a double-blind, randomized controlled trial.

Number: 106 adult mechanically ventilated medical and surgical ICU patients. Patients were sedated with dexmedetomidine or lorazepam for as many as 120 hours.

Scales used:

• Richmond Agitation-Sedation Scale (RASS).
• Patients were monitored twice daily for delirium using the Confusion Assessment Method for the ICU (CAM-ICU).

Results :

• Sedation with dexmedetomidine resulted in more days alive without delirium or coma (median days, 7.0 vs 3.0)
• a lower prevalence of coma (63% vs 92%)
• Patients sedated with dexmedetomidine spent more time within 1 RASS point of their sedation goal compared with patients sedated with lorazepam (median percentage of days, 80% vs 67%)
• The 28-day mortality in the dexmedetomidine group was 17% vs 27% in the lorazepam group
• cost of care was similar between groups
• The 12-month time to death was 363 days in the dexmedetomidine group vs 188 days in the lorazepam group

Conclusion: In mechanically ventilated ICU patients managed with individualized targeted sedation, use of a dexmedetomidine infusion resulted in more days alive without delirium or coma and more time at the targeted level of sedation than with a lorazepam infusion.


Related previous pearl: Regarding Dexmedetomidine (Precedex)




Reference: click to get abstract/article

1. Effect of Sedation With Dexmedetomidine vs Lorazepam on Acute Brain Dysfunction in Mechanically Ventilated Patients , The MENDS Randomized Controlled Trial, JAMA. 2007;298(22):2644-2653.