Sedation of initially intubated and mechanically ventilated patients during treatment in an intensive care setting; should not be used for >24 hr.
Acts as a relatively selective alpha-adrenergic agonist with sedative properties. Therapeutic Effects: Sedation.
Adverse Reactions/Side Effects
Resp: hypoxia. CV: BRADYCARDIA, SINUS ARREST, hypotension, transient hypertension. GI: nausea, vomiting. Hemat: anemia. Misc: fever.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess heart rate, ECG, and heart sounds (See Appendices G, H). Report slow heart rate (bradycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, fainting, and fatigue/weakness.
Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).
Monitor signs of low oxygen levels (hypoxia) or anemia, including pallor and cyanosis. Monitor pulse oximetry to quantify suspected problems with mechanical ventilation or blood delivery to tissues.
Absorption: IV administration results in complete bioavailability.
Metabolism and Excretion: Mostly metabolized by the liver, some metabolism by P450 enzyme system. Metabolites are mostly excreted in urine.
Contraindicated in: Hypersensitivity.
Use Cautiously in: Hepatic impairment (lower doses may be required); Advanced heart block; Geriatric patients (increased risk of bradycardia and hypotension in patients ≥65 yr; Pregnancy, lactation or children (safety not established).
Drug-Drug: Sedation is enhanced by anesthetics, other sedative/hypnotics, and opioid analgesics.
Drug-Natural: Concomitant use of kava, valerian, skullcap, chamomile, or hops can ↑ CNS depression.
IV (Adults): Loading infusion—1 mcg/kg over 10 min followed by maintenance infusion of 0.2–0.7 mcg/kg/hr for maximum of 24 hr; rate is adjusted to achieve desired level of sedation.
Injection: 100 mcg/mL in 2-mL ampules and vials.