Anesthetics/sedatives, hypnotics, and opioids-
Coadministration of dexamethitomide with anesthetics , sedatives, hypnotics, and opioids
lead to enhancement of toxic effects.

Intensive care unit sedation-

Adverse effects-

Cardiovascular -  atrial fibrillation  4%    bradycardia 4%  hypertension 10%
                               hypotension  23%      tachycardia 2%   

GI -                         dry mouth  3%    nausea 8%    vomiting  3%

Metabolic/ nutrional -   hyperglycemia   2%    hypovaolemia   3%

Respiratory -       hypoxia   2%     pleural effusion 2%

Miscellaneous -    agitation 2%      anemia 2%     chills 2%    hyperthermia 2%
                                pyrexia 3%  

Special Precautions-
Administration- dexamedtomidine should be administered only by persons skillied in
mangement of patients in intensive care operating room setting

Cardiac effect- significant episodes of bradycardia and sinus arrest have been reported
with dexmedetomide  administration in young.
Excercise caution while administering dexmedetomidine to atients with heart block or
severe ventricular dysfunction.

Renal function impairment - dexmedetomidine is known to be sunbstantially excreted by
the kidney and risk of adverse reactions may be greater in patients with impaired
renal function.

Hepatic function impairment-  consider dose reduction in patients with hepatic function.

Pregnancy- use dexmedetomidine during pregnancy only if required

Lactation- excercise caution when dexmedetomidine is administered to a beast feeding woman

Children- do not use dexmedetomidine use in children younger than 18 years of age.

Elderly- because elderly patients are more likely to have decreased renal function, take care of
dose selectionin elderly patients

Indication-

Intensive care unit sedation

Dosage-
Loading dose- 1mcg/kg/hr
The rate of maintaing infuson should be adjusted to acheive the desired level of sedation

Elderly- dose reduction should be considered

1. Monitor blood pressure, heart rate, and oxygen levels both continously during the infusion of
    dexmedetomidine and as clinically appropiate after discontination.

2. When dexmedetomidine is infused for more than 6 hours, instruct patients to report
    nrvousness, agitation, and headaches that may occur for upto 48 hours

3. Advice patients to report symptoms that may occur within 48 hours after administration
   such as weakness, excessive sweating, weight loss, abdominal pain, salr cravings, diarrhea,
  dizzines or light-headedness.

Pregnancy-
Use dexmedetomidine during pregnancy only if required

Lactation-
Excercise caution when dexmedetomidine is administered to a beast feeding woman

Children-
Do not use dexmedetomidine use in children younger than 18 years of age.

Elderly-
Because elderly patients are more likely to have decreased renal function, take care of
dose selectionin elderly patients