Audit shows compliance to the standards were not met. A third of the patients required higher doses of up to 2 micrograms/kg/hour of dexmedetomidine.

Studies have supported the safety of higher doses of up to 2 micrograms/kg/hour.2 Other hospital guidelines recommend dose ranges of 0.1–1.4 micrograms/kg/hour as a continuous infusion.

There were 6 patients who had valid reasons for longer durations.

Other hospital guidelines have suggested that in most cases treatment should not exceed 72 hours however this may be extended to 7 days at consultant discretion provided that there has been a benefit from the initial 72 hours of treatment and it has led to successful reduction in doses of other sedative agents.

An update of our guidelines in line with usual practice seems appropriate.

Limitations include not being able to correlate higher doses of dexmedetomidine to being over sedated as sedation is subjective.

A point of consideration includes whether weaning protocols need to be standardized considering side effect profiles.

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