Overview
Overview
- Intravenous Alpha-2 agonist with sedative and analgesic effects
- Produces sedation without significant effect on respiratory drive
- Produces less hypotension and has a more predictable haemodynamic profile than clonidine
- Primarily used in intensive care and anaesthesia due to the requirement for administration as an intravenous infusion
- Intravenous Alpha-2 agonist with sedative and analgesic effects
- Produces sedation without significant effect on respiratory drive
- Produces less hypotension and has a more predictable haemodynamic profile than clonidine
- Primarily used in intensive care and anaesthesia due to the requirement for administration as an intravenous infusion
Indications & Dosing
Indications & Dosing
Sedation on critical care
- Sedation of intubated and mechanically ventilated patients as a sole agent or as an adjunct to others:
- May reduce days of ventilation
- May reduce rates of delirium
- Treatment of agitated and delirious patients
- Must be weaned gradually
IV loading: (usually avoided if critically ill or haemodynamically unstable) 0.5-1.0 mcg/kg
IV Infusion: 0.2-0.7 mcg/kg/hr (can increase cautiously to 1.5 mcg/kg/hr)
IV Infusion: 0.2-0.7 mcg/kg/hr (can increase cautiously to 1.5 mcg/kg/hr)
Adjunct to anaesthesia
- Reduces MAC of volatile agents
- Has some analgesic properties (reduces opiate requirement)
- Reduces postoperative nausea
- Reduces emergence delirium
IV loading: 0.5-1.0 mcg/kg
IV Infusion: 0.2-0.7 mcg/kg/hr (can increase cautiously to 1.5 mcg/kg/hr)
IV Infusion: 0.2-0.7 mcg/kg/hr (can increase cautiously to 1.5 mcg/kg/hr)
Procedural sedation
- Useful for awake intubation
Adjunct to regional anaesthesia
- Prolongs duration of effect
- Useful in peripheral nerve, epidural, caudal and spinal blocks
Contraindications
Contraindications
- No definitive contraindications
- Extreme caution should be exercised in patients with:
- Heart block
- Bradycardia
- Hypotension or hypovolaemia
- Severe ventricular dysfunction
- Peripheral vascular disease
- Concomitant use of:
- Beta-blockers (bradycardia)
- Tricyclic antidepressants (counteract effect)
- Digoxin (bradycardia)
- Haloperidol (prolongation of QT interval)
- Caution should be exercised when using as a sole sedative agent in patients <65 years of age (signal toward worse outcomes)
- Sudden withdrawal should be avoided due to the risk of rebound hypertension
- No definitive contraindications
- Extreme caution should be exercised in patients with:
- Heart block
- Bradycardia
- Hypotension or hypovolaemia
- Severe ventricular dysfunction
- Peripheral vascular disease
- Concomitant use of:
- Beta-blockers (bradycardia)
- Tricyclic antidepressants (counteract effect)
- Digoxin (bradycardia)
- Haloperidol (prolongation of QT interval)
- Caution should be exercised when using as a sole sedative agent in patients <65 years of age (signal toward worse outcomes)
- Sudden withdrawal should be avoided due to the risk of rebound hypertension
Formulation
Formulation
Intravenous
Vial: 200mcg/2ml, 400mcg/4ml or 1000mcg/10ml
Preparation
Preparation
- Suggested standard infusion in critical care
- Dilute to 4mcg/ml or 8mcg/ml
- Sodium chloride 0.9% or glucose 5% can be used
- Suggested standard infusion in critical care
- Dilute to 4mcg/ml or 8mcg/ml
- Sodium chloride 0.9% or glucose 5% can be used