课件：ICU-的镇静与镇痛.pptVIP

* Speaker’s Notes: Dexmedetomidine decreases heart rate and/or blood pressure, and must be used cautiously with atrial/ventricular conduction abnormalities, especially if ventricular pacing is not readily available as back up. Because dexmedetomidine can produce vasodilation, it may exacerbate hypotension in hypovolemic patients, as any vasodilator has the potential to be potentiated with hypovolemia. Dexmedetomidine should not be administered to the patient with shock and/or vascular collapse Patients with advanced heart block are not candidates for dexmedetomidine therapy because of the possible consequences of bradycardia. * Speaker’s Notes: Dexmedetomidine may potentiate other sedatives/ hypnotics, opioids, anesthetics, vasodilating agents, or other vasoactive agents. * Speaker’s Notes: Some of the dexmedetomidine patients are arousable and alert when stimulated. Until clinicians become familiar with dexmedetomidine, there is concern that they may interpret this alertness as a lack of effect and increase sedation with supplemental drugs. In the studies with dexmedetomidine, patients were cooperative and easily managed during manipulations, and then returned to their sedated sleep, tolerant of the endotracheal tube. * Speaker’s Notes: Unlike other ICU sedation agents, it is not necessary to wean the patient from dexmedetomidine for extubation. Dexmedetomidine Caveats(1) Dexmedetomidine may produce sympatholysis with hypotension and bradycardia. Therapeutic approaches when required include: Decrease/stop the infusion IV fluid administration Elevate the lower extremities Administer vasopressor agents Dexmedetomidine Caveats(2) Use with caution in patients with advanced heart block Use with caution in hypovolemic patients Do not use if the patient is in shock Transient increases in blood pressure may occur during the loading infusion Dexmedetomidine Caveats(3) Dexmedetomidine may potentiate the effects of other agents including Opioids Sedatives/hypno