Hi everyone, I hope you are all doing well. I can’t believe it is almost Christmas. Time flew by. I have been absent for a little while as I mentioned that I started my new job at an academic center. Starting this August, I took on research projects. I have submitted two prospective clinical research trial proposals and hopefully I will get something next year.
I have been thinking lately what I should write for my next post. I felt that I have been running out of topics. I am going to change it up a little next year for this site. I will start posting case tips and case studies for students in the year of 2019. If you have any feedback, please let me know.
I know we all have used precedex and I have also discussed precedex in a previous post. If you need to revisit the MOA, please click on the link below How to Prolong Spinal When You Don’t Want to Convert to GA?. It is a perfect drug for the aortogram MAC case. Typical patients who require aortogram runoffs have medical history of mostly vascular diseases, DM, HTN. Many are obese and have sleep apnea. Laying on the table for a long time, it could be very uncomfortable for patients. But if we give fentanyl, we may run into risk of sleeping apnea. In addition, if you use propofol, they may forget where they are and move on the table. Precedex is a perfect drug in this scenario. Last time, I used it on a morbidly obese patients. I started out at 0.7mcg/kg/min without bolus when patient got in the room. It usually takes sometime to get patient settle such as connecting patient to the monitor, position patient etc. It roughly took about 20mins for the precedex to kick in. Throughout the case, patient had very stable hemodynamics, never obstructed, and followed commands as needed. Fantanyl was never needed. I titrated down the precedex as the case was almost done. Patient woke up when we took him to the PACU.
Some people may worry about the effect of precedex on hemodynamics. The effect of precedex on hemodynamics is very minimal. It is a great drug choice for this type of procedure. Try it out next time and let me know what you think.
Happy Holidays everyone!