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- Sep 22, 2014
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I've given dexmedetomidine intra-operatively exactly twice (both as infusions). One person developed complete heart block and the other took so long to wake-up that I extubated them and stuck an LMA in for PACU.
I like giving IV clonidine 0.5 - 1mcg/kg for bigger abdominal cases or for people on lots of opioids at baseline both prescription and otherwise.
On the other hand, I’ve given hundreds of patients dexmedetomidine via boluses/infusions and can’t remember any high degree heart block ever. Moderate chance of bradycardia but rarely hemodynamically significant. More issues with PACU hypotension in wide awake patients which has made me use it a lot less.
Agree with longer extubation times which is why I stopped doing high-dose infusions and turn it off early (if I use it at all).
I like low-dose infusions for TAVIs (in addition to prop/opioids) and “awake” carotids, but overall agree it’s probably over-used in a lot of situations. I’m not sure I agree that clonidine is any better than dexmedetomidine given its lower alpha-2 selectivity and propensity for hypotension. Maybe more cost effective at some institutions but not here.