Dexmedetomidine (Burns ICU Sedation)

Fetched UK SPC is Dexdor 100 micrograms/ml concentrate for solution for infusion (https://www.medicines.org.uk/emc/product/4783/smpc), licensed for sedation of adult ICU patients requiring a sedation level not deeper than arousal in response to verbal stimulation (Richmond Agitation-Sedation Scale, RASS, 0 to -3). Dexmedetomidine is very potent — note the units are micrograms/kg/HOUR, not per minute. A lower starting infusion rate should be considered for frail patients. USE OF A LOADING DOSE IN ICU SEDATION IS NOT RECOMMENDED and is associated with increased adverse reactions; do not give as a bolus; propofol or midazolam may be administered if needed until the clinical effects of dexmedetomidine are established. Duration: there is no experience of use for more than 14 days, and use beyond this should be regularly reassessed. PROCEDURAL/AWAKE SEDATION of non-intubated adults before and/or during diagnostic or surgical procedures (a separate indication in the same SPC): initiation — a loading infusion of 1.0 microgram/kg over 10 minutes, or 0.5 micrograms/kg over 10 minutes for less invasive procedures such as ophthalmic surgery; maintenance — generally initiated at 0.6-0.7 microgram/kg/hour and titrated to the desired clinical effect within a range of 0.2 to 1 microgram/kg/hour. For procedural sedation, patients must be continuously monitored by someone not conducting the procedure, for early signs of hypotension, hypertension, bradycardia, respiratory depression, airway obstruction, apnoea, dyspnoea and/or oxygen desaturation, with pulse oximetry and supplemental oxygen immediately available; concomitant local anaesthesia or additional analgesia/sedation (opioids, midazolam, propofol) may be needed for painful procedures. Distribution half-life is around 6 minutes. Elderly: no dose adjustment is normally required, but patients over 65 appear to be at increased risk of hypotension and a dose reduction should be considered for procedures. Hepatic impairment: dexmedetomidine is metabolised in the liver and should be used with caution; a reduced maintenance dose may be considered. Not to be used as a general anaesthetic induction agent for intubation, to provide sedation during muscle relaxant use, for patients requiring continuous deep sedation, or for patient-controlled sedation. It lacks anticonvulsant action and will not suppress underlying seizure activity. All patients should have continuous cardiac monitoring, and respiration should be monitored in non-intubated patients. PAEDIATRIC: the safety and efficacy of Dexdor in children aged 0 to 18 years have NOT been established and no recommendation on a posology can be made — verify any under-18 use against a children's formulary. CROSS-CHECK ONLY — the US label (Dexmedetomidine Injection, WG Critical Care, 2026-06-02) differs from the UK SPC: adult ICU sedation initiate at 1 mcg/kg over 10 minutes followed by a maintenance infusion of 0.2 to 0.7 mcg/kg/hour; adult procedural sedation initiate at 1 mcg/kg over 10 minutes followed by maintenance initiated at 0.6 mcg/kg/hour and titrated within 0.2 to 1 mcg/kg/hour; administration duration should not exceed 24 hours. Confirm which regimen applies locally before publishing.