I remember the time when Propofol just came on the market and the generic form was not available yet. Despite a high price tag, the benefits of using an ultra-short acting sedative for the critically ill patient became apparent very quickly. Rapid titration of the sedation allowed us to cut down on the ventilator days and decrease the length of stay in the Intensive Care Unit. Propofol is not without drawbacks, though. The price has been reduced so that now we have intermittent shortages of the medication. Lipid levels should be monitored since the drug is based on fat emulsion. Feared, but real, Propofol infusion syndrome limits it’s long term use in high doses. And, of course, the bad publicity this drug received after the death of a popular singer…

Now, we have a new player on the marker – Precedex or Dexmedetomide. The clinical data is yet limited and the medication is only approved for use for just 24 hours at at at time. Since it is an alpha-2 agonist, low blood pressure is the biggest concern. The greatest benefit, though, is that the patient does not have to be intubated to receive a continuous infusion of Precedex. This is a great benefit. In clinical practice, using Precedex for patients going through a severe alcohol withdrawal often works better than anything else. If the patient remains agitated despite escalating doses of benzodiazepines, Precedex works really well. Those are the patients who would be intubated and started on a Propofol infusion, otherwise.

A very recent study published in The Critical Care Medicine Journal compares the total cost of care when Precedex or Versed are being used. The patients in the Precedex group had reduced duration of mechanical ventilation and ICU length of stay. Sedation with Precedex was significantly less costly because of that. What is also remarkable – the drug was being used well beyond the recommended 24 hours without major safety concerns.

Well, it sounds like we have a new kid on the block. I predict that Precedex will definitely find it’s use in the Intensive Care Unit.