Dexmedetomidine
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Bradycardia leading to asystole: case report An 18-year-old girl experienced episodes of bradycardia that culminated in transient asystole while receiving an infusion of dexmedetomidine. The girl, who had undergone a double lung transplant, had been hospitalised with complications requiring intubation and sedation. She received a loading dose of dexmedetomidine 1 µg/kg administered over 10 minutes, followed by an infusion 0.4–0.7 µg/kg/h, for weaning from a propofol infusion and allowing extubation; her propofol infusion was decreased, but attempts to reduce her concomitant fentanyl infusion were unsuccessful. Over the next several hours, she experienced episodes of agitation and coughing that required bolus doses of propofol, fentanyl and lorazepam. Her dexmedetomidine infusion rate was increased to a maximum of 0.8 µg/kg/h, which she received for approximately 1 hour. Eight hours after starting dexmedetomidine, she developed a coughing spasm with associated bradycardia, which progressed to a 10-second episode of transient asystole on an ECG. She experienced three further episodes of bradycardia with transient asystole at 12, 15 and 22 hours during her dexmedetomidine infusion. The girl’s dexmedetomidine infusion was discontinued after 23 hours. Three hours later, she experienced one further episode of bradycardia with transient asystole. Her respiratory status then improved, with a decrease in the frequency and severity of her coughing spasms. Her propofol infusion was successfully discontinued, and she was successfully extubated. She was subsequently discharged to a rehabilitation facility. Author comment: "Likely concurrent triggers included opioid administration and coughing spells that were not controlled by the sedative regimen." Zhang X, et al. Bradycardia leading to asystole during dexmedetomidine infusion in an 18 year-old double-lung transplant recipient. Journal of Clinical Anesthesia 22: 45-49, No. 1, Feb 2010. Available from: URL: http://dx.doi.org/10.1016/ 803018152 j.jclinane.2009.06.002 - USA
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Reactions 5 Jun 2010 No. 1304
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