Document Detail

Dexmedetomidine-associated bradycardia progressing to pulseless electrical activity: case report and review of the literature.
MedLine Citation:
PMID:  19947809     Owner:  NLM     Status:  MEDLINE    
Dexmedetomidine is an alpha(2)-agonist indicated for sedation in critically ill patients and procedural sedation in nonintubated patients. It is a distinctive sedative because it does not cause respiratory depression, but it may cause hypotension and bradycardia. We describe a 74-year-old man who was receiving dexmedetomidine for agitation and experienced progressive bradycardia. The patient experienced a postoperative myocardial infarction 3 days after repair of an abdominal aortic aneurysm. A dexmedetomidine infusion was started at 0.11 microg/kg/hour, without a loading dose, for agitation; the patient's heart rate was 123 beats/minute and blood pressure was 147/70 mm Hg, both within normal limits. Over the next 6 hours, the dexmedetomidine infusion rate was increased to a maximum of 0.7 microg/kg/hour; the patient's heart rate progressively decreased to 21 beats/minute, followed by pulseless electrical activity. After 2 minutes of chest compressions and an intravenous bolus of atropine 0.4 mg, the patient regained a pulse. Dexmedetomidine was discontinued, and the patient's heart rate and blood pressure returned to within normal limits. The patient was discharged home 7 days later without any cardiac or neurologic sequelae. Clinicians need to be educated about the potential for dexmedetomidine to cause bradycardia progressing to pulseless electrical activity, and patients need to be closely monitored. Patients who receive dexmedetomidine and develop a greater than 30% decrease in heart rate may be at high risk for severe bradycardia leading to pulseless electrical activity. We urge caution when using dexmedetomidine, especially in patients with significant cardiac disease.
Anthony T Gerlach; Claire V Murphy
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pharmacotherapy     Volume:  29     ISSN:  1875-9114     ISO Abbreviation:  Pharmacotherapy     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-01     Completed Date:  2010-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8111305     Medline TA:  Pharmacotherapy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1492     Citation Subset:  IM    
Department of Pharmacy, The Ohio State University Medical Center, Ohio 43210, USA.
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MeSH Terms
Bradycardia / chemically induced*,  physiopathology
Dexmedetomidine / administration & dosage,  adverse effects*,  therapeutic use
Dose-Response Relationship, Drug
Hypnotics and Sedatives / administration & dosage,  adverse effects*,  therapeutic use
Infusions, Intravenous
Psychomotor Agitation / drug therapy
Reg. No./Substance:
0/Hypnotics and Sedatives; 113775-47-6/Dexmedetomidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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