Precedex for Anesthesia providers: 
Precedex binds to pre-synaptic alpha 2 receptors, inhibiting norepinephrine and catecholamine release. (Increased doses can bind to postsynaptic receptors 
1. 94% protein bound (caution in hepatic patients, dose reduction should be considered
2.Reduces inhalational anesthetic requirement (MAC) 
3. Onset 10-15 minutes (Give Early depending on when you want to see effects
4. Peak effect in 15-20 minutes 
5. Intranasal onset 45-60 minutes, with peak effect 90-105 minutes 
6. Distribution half-life= 5 minutes 
7. Plasma half-life (T1/2)= 2-3 hours (infusions will be longer) 
8. Elimination half-life= 2 hours (infusions will be longer) 
9. Studies have shown it decreases inflammatory markers 
10. It is not an analgesic, but has opioid sparing effects 

Pediatric Precedex (Dexmedetomidine) Dosing 
Pre Op: Intranasal Dosing 2mcg/kg is equivalent to 0.5mg/kg of Versed 
Must be given 45 minutes before going back to OR, and total dose usually divided between 2 syringes for atomizers 
Intra Op: 0.3 – 1.0 mcg/kg (Dosed at 4 – 8 mcg at a time) 
- Typical dose for smooth emergence is 4 – 20 mcg pushed over 5 min 
- Decide total dose wanting to be given (typically 0.5mcg/kg), give ¼ to ½ the dose over a minute at a time. Pay attention to HR, if bradycardia presents stop or bolus slower once brady resolves (kids have increased vagal tone) 

Post Op: Dosing is same as smooth emergence 
Types of cases: Pediatric dental, T&A’s, other ENT procedures, and to prevent/treat postop delirium. If short case, give at the beginning. If new to this drug (provider) it’s a good idea to under dose for short case (0.2-0.3mcg/kg) to 
prevent giving too much causing sluggishness increasing PACU times. If given at lower dose, but still thrashing on wakeup, give a little propofol, followed by more precedex. Provider technique will improve once you gain a little more confidence with using this drug. Just remember, it doesn’t have an instant effect. 

Adult Precedex Dosing 
Dosing is very similar to pediatric population. Acute Bradycardia and Hypotension are common side effects
- 0.3 – 1.0 mcg/kg is common for both the intraoperative phase and postoperative emergence 
- Infusion and sedation doses 0.2 – 1.0 mcg/kg/hr 

Types of cases: Short procedural cases (0.5-1mcg/kg slow push preoperatively at least 10-15 min before stimulation, then 10-20 mg push propofol for local injection), MAC for totals (with spinals) bolus dose precedex (give early) then propofol gtt can be 25-50mcg/kg/min vs higher rates and higher resp. depression risks. TAVR sedation and endovascular MAC cases (use caution in severe cardiac issues (low EF) l lower lower dose and give slower), neurosurgery, and OB cases. 
Also useful to treat withdrawl from benzos, opioids, alcohol, and recreational drugs. And it can be used as an antishivering agent. 

References 
Kaur, M. & Singh, P.M. (2011). Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesthesia, essays and researches, 5(2),128. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173414/. 
Liu, Y.,Liang, F., Liu, X.,Shao, X.,Jiang, N.,&Gan, X. (2018). Dexmedetomidine reduces perioperative opioid consumption and postoperative pain intensity in neurosurgery: a meta-analysis. Journal of neurosurgical anesthesiology, 30(2), 146-155. 
McEvoy, M.D.,Scott, M.J., Gordon, D.B., Grant, S.A., Thacker, J.M., Wu, C.L., &Miller, T.E. (2017). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within enhanced recovery pathway for colorectal surgery:part I -from the preoperative period to PACU. Perioperative Medicine, 6I. doi:IO.II86/sI374I-017-0064-5.