Dexmedetomidine
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Acute biventricular systolic heart failure: case report A 71-year-old man developed acute biventricular systolic heart failure following sedative treatment with dexmedetomidine. The man, who underwent an unsuccessful ERCP, was admitted to an ICU due to acute obstructive pancreatitis. His medical history included post-traumatic stress disorder, depression, chronic atrial fibrillation and CABG. Two weeks before the hospitalisation, he experienced mild LV systolic dysfunction and grade-II diastolic impairment. On hospitalisation day 2, he developed atrial fibrillation with rapid ventricular response, which lasted 24 hours and was treated with amiodarone and diltiazem. Later, he developed delirium with worsening agitation and work of breathing required haloperidol and unspecified benzodiazepine followed by dexmedetomidine infusion [dose not stated] and fentanyl drip. He was intubated and high doses of dexmedetomidine were given for sedation. After weaning of the sedatives, he was found delirious and agitated. He was extubated on the fifth day of the hospitalisation, however re-intubation was required the next day due to a new pulmonary oedema. An ECG showed atrial flutter. On hospitalisation day 8, an echocardiogram revealed left ventricular (LV) systolic dysfunction with ejection fraction (EF) 15%, severe systolic dysfunction and right ventricular dilation, consistent with acute systolic heart failure. The man was treated with furosemide and his pulmonary oedema resolved. Thereafter, dexmedetomidine was discontinued and he was successfully extubated on hospitalisation day 11. A repeat echocardiogram showed left ventricular EF 45%, normal right ventricular size and function on hospitalisation day 18. Faggioni M, et al. A case of acute systolic heart failure induced by prolonged dexmedetomidine infusion. American Journal of Respiratory and Critical Care Medicine 199: 803446988 abstr. A6635, No. 9, May 2019. Available from: URL: https://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6635 [abstract]
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Reactions 18 Jan 2020 No. 1787
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