DISCLAIMER: This is not an advertisement. The author of this post has no direct or indirect affiliation with Precedex manufacturer or its affiliates.
The post below is an author’s personal opinion and cannot be considered as practice guidelines.

There is a category of trauma patients; I call them “wild and unruly”. Usually it is a young male who ingests a large amount of alcohol along with some cocaine, marijuana or amphetamines and proceeds to have a good time at a party or elsewhere. Subsequently, he will get into some sort of altercation or accident and is brought to ER as a trauma patient.

At this point the patient, often, is wild, restless and combative. Evaluating this patient for possible injuries is almost impossible. The patient often gets intubated, sedated and paralyzed, just so that all the necessary XRs and CT scans can be done.

Afterwards, the patient is taken to the Intensive Care Unit. No significant head, chest or abdominal injuries are found to preclude the patient from being taken off the ventilator. Now, I am facing the task of extubating the patient as soon as possible. The “as soon as possible” part of this task can be very challenging.

A lot of these patients exhibit “all or nothing” behavior. The patient is either completely unresponsive while being sedated (Propofol in most cases) or is being wild and combative once the sedation is lightened up. The usual course of action is to wait until the patient is more cooperative. The thing is, though, it can take many hours or even a couple of days for some individuals to sober up.

Using Precedex as a bridge to the coherent and cooperative state might help to facilitate extubation. The patient can be started on Precedex along with Propofol. The Propofol drip will be weaned off. The patient will be assessed for readiness for extubation. This usually involves performing weaning trials in a pressure support mode.

Once the patient is off the ventilator, the Precedex drip will be slowly weaned off depending on the patient’s condition.

Once again, there are absolutely no randomized trials on using Precedex for these indications. This represents the author’s personal experience and cannot be considered as practice guidelines.