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Dexdomitor® (Dexmedetomidine) Procedure

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Megan Brashear, CVT, VTS(ECC), discusses using dexmedetomidine (Dexdomitor®) on a cat during a laceration repair, and the specific effects on the patient, reversal of the drug, and patient monitoring involved.

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Megan Brashear's picture
Megan Brashear

CVT VTS(ECC)

Enrolled: 07/2011

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Megan Barclay's picture

Are there particular cases you would advise not to use Dexdomitor in?

Megan Brashear's picture

Hi Megan, there are certain cases where we would not want to use dexmedetomidine for it's sedative properties - mainly our unstable critical cases. Any patient that is not stable (meaning blood pressure, heart rate, perfusion) prior to sedation/anesthesia does not get dexmedetomidine. We use it mostly on the ER side for quick laceration repairs and other minor procedures. That being said, we do use micro doses for analgesia in some of our critical patients and it works wonders!

Julie Ann Hamlet's picture

I am wondering, do you prefer to give Dexdomitor IM as opposed to IV, and if so, what are the differences that you see in the effects? At my hospital, there are a couple doctors that use Dexdomitor regularly, and they all prefer to give it IV because of the faster onset. I've assisted in a couple Dexdomitor procedures where it was given IM, and the patients experienced a paradoxical reaction and became hyperstimulated, perhaps because the Dexdomitor took longer to take effect and the patients were frightened by gradually becoming drowsy and tried to fight it. Any insight would be appreciated.

Julie Ann Hamlet's picture

I am wondering, do you prefer to give Dexdomitor IM as opposed to IV, and if so, what are the differences that you see in the effects? At my hospital, there are a couple doctors that use Dexdomitor regularly, and they all prefer to give it IV because of the faster onset. I've assisted in a couple Dexdomitor procedures where it was given IM, and the patients experienced a paradoxical reaction and became hyperstimulated, perhaps because the Dexdomitor took longer to take effect and the patients were frightened by gradually becoming drowsy and tried to fight it. Any insight would be appreciated.

Chris Carrasco's picture

Do you use the Surgivet to monitor all of your cases using Dexdomitor in your hospital? Our treatment area they tend to be hard to come by when needed but I know I typically feel more comfortable if I can see an ECG and a blood pressure on patients I'm monitoring

Megan Brashear's picture

Julie Ann, I apologize for the delay of time in answering. In my experience, more important than the route of giving dexdomitor, is the amount of time given to the patient to allow them to get to that deep plane of sedation. Even when we give the drug IV if we do not wait long enough the patient is hyper-reactive and they may fight the procedure. When given IM, just give the patient TIME to get into the right plane of sedation for the procedure before stimulating them. I will often cover their eyes and ears with a towel (if possible) to reduce stimulation.

Megan Brashear's picture

Chris, we are lucky here at DoveLewis to have 3 multiparameter anesthesia monitors so we can place all sedated and anesthetized patients on them. I too like to see an ECG, Sp02 and BP at minimum on sedated or anesthetized patients. Especially with dexmedetomidine, I will also use pulses and other perfusion parameters to monitor as well. As much as I love our SurgiVet, it can never take the place of an alert technician!

julia moscardon's picture

Do you know how to do the calculations for dexdomitor and antisedan? I know they provide dosing charts but I have to show my calculations for an assignment and am having a hard time figuring it out...any help is appreciated !

Rachel Medo's picture

Hi Julia,

I was able to check in with one of our technicians here about your question.

For Dexdomitor, it depends on the size of the patient and what the drug is being administered for (i.e. sedation or surgery). This also goes for antisedan, which is usually administered at the same dose as Dexdomitor (for example if 1ml IV of dexmed is given, 1ml of Antisedan IM would be administered for reversal).

You can follow this link, https://www.zoetisus.com/products/pages/dexdomitor/index.asp, where you can print out PDFs showing the dosage in relation to body weight.

Please let me know if I can answer any further questions!

Rebecca Mundy's picture

Hi Megan, one of our doctors likes to give the antisedan IV. What is reasoning behind only giving it IM.

James Reid's picture

Hello Rebecca, Thanks for the question! I work in the surgery department at Dove Lewis and I am going to try and answer your question. First off this a great question and I see it discussed often. First off, I need to state that Antisedan is only labeled for intramuscular use in dogs. However, as you know, in vet med we frequently go off- label with our medications (we use it in cats all the time). I personally have never given Antisedan IV and I will explain why. Dexmeditomidine causes profound vasoconstriction which increases blood pressure. This is why we see the reflex bradycardia. I would worry with a very rapid reversal of that vasoconstriction there is potentially not enough time for the sympathetic nervous system to increase the cardiac output. This could potentially result in severe hypotension which could lead to cardiac collapse. I also prefer my patients to have a smooth recovery from sedation and anesthesia. I personally haven't worked anywhere that administers Antisedan IV but I have heard of DVM's, Techs, and even anesthesiologists giving it IV. In those cases I believe the Antisedan was given to effect, given as a half dose, given slowly, or for quick reversal during CPR. Plumbs doesn't really give much information for why not to give it IV. In the 9th edition it states never give it IV to reptiles because of severe hypotension. It also states the adverse effects; vomiting, diarrhea, hypersalivation, excitation, and tremors. Could these adverse reactions be seen more often or more severe if given IV? I've also read that Antisedan may need to be administered a second time. Could giving it IV increase the need to administer another dose? Unfortunately my textbooks don't really go into much detail about giving Antisedan IV. I would be curious if anyone knows of any studies done on this topic. I prefer to follow the old quote "There is no safe anesthesia. Only safe anesthetists." I hope this answers your question and please let me know if you have any further questions.