Bradycardia leading to asystole during dexmedetomidine infusion in an 18 year-old double-lung transplant recipient

Zhang, Xiaopeng; Schmidt, Ulrich; Wain, John C.; Bigatello, Luca M.

doi:10.1016/j.jclinane.2009.06.002

Cited by 40 publications

(36 citation statements)

References 26 publications

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“…DEX has been increasingly used for operative anesthesia and in the pediatric intensive care unit for postoperative care (4 -6). Its ability to induce sedation and analgesia enable it to serve as a sole sedative or as an adjunct drug during mechanical ventilation and/or sedation-dependent procedures (7)(8)(9). The terminal half-life of DEX established in adult patients is 110 mins (10) and the drug was approved by the Food and Drug Administration for continuous infusion of 0.2 to 0.7 g/kg/hr for up to 24 hrs for sedation (7,11).…”

mentioning

confidence: 99%

“…Its ability to induce sedation and analgesia enable it to serve as a sole sedative or as an adjunct drug during mechanical ventilation and/or sedation-dependent procedures (7)(8)(9). The terminal half-life of DEX established in adult patients is 110 mins (10) and the drug was approved by the Food and Drug Administration for continuous infusion of 0.2 to 0.7 g/kg/hr for up to 24 hrs for sedation (7,11). A preliminary study in pediatric patients has established the terminal half-life of DEX to be 2.65 (Ϯ 0.88 hrs) (12); the safety and effectiveness in children Ͻ18 yrs of age are now being studied but have not yet been established (13).…”

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confidence: 99%

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Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery

Shepard

Tejman‐Yarden

Khanna

et al. 2011

Critical Care Medicine

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confidence: 99%

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confidence: 99%

Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery

Shepard

Tejman‐Yarden

Khanna

et al. 2011

Critical Care Medicine

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“…25 In rare cases, sinus arrest has been reported. 26,27 Hypotension and bradycardia appear to occur at lower rates in children. In 1 large trial of more than 1200 children, the reported incidence of hypotension was 2.2%, and in another trial of dexmedetomidine in 315 children with behavioral disorders, the incidence of hypotension and/or bradycardia was ,3%.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine for Transport of a Spontaneously Breathing Combative Child

Watt

Walgos²,

Cheifetz

et al. 2012

Pediatrics

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Interhospital transport presents a challenge for pediatricians, and airway protection is often a significant concern. The severely agitated child without respiratory compromise poses an extremely difficult dilemma, as most sedative agents can cause respiratory depression. Intubation offers definitive control of the airway but is not without risk, especially in an environment where experience and resources for pediatric intubation may be limited. Dexmedetomidine may be used for sedation in certain circumstances for the transport of a child without the need for intubation and mechanical ventilation.

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“…Medicamentos como la dexmedetomidina han demostrado una adecuada respuesta clínica y baja tasa de complicaciones respiratorias, así como menor incidencia de delirium (10)(11)(12)(13)(14) A pesar de los beneficios de dexmedetomidina para sedación, también se ha asociado a eventos adversos graves como bradicardia severa, hipotensión e incluso, paro cardiaco (15)(16)(17). Su uso en diferentes procedimientos, asociados a diferentes modalidades de anestesia tambien se ha visto relacionado con episodios de bradicardia, que requieren de manejo con atropina para la prevención de complicaciones hemodinámicas mas severas (18,19). Sin embargo, no se conocen estudios respecto a las complicaciones cardiovasculares en procedimientos como la cirugía microgá-fica de Mohs con requerimiento de sedación.…”

Section: Introductionunclassified

Anestesia loco regional más sedación con dexmedetomidina para cirugía de Mohs con reconstrucción

et al. 2018

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Comparte ResumenIntroducción: la cirugía micrográfica de Mohs se emplea para la escisión de tumores cutáneos malignos y frecuentemente es seguida de reconstrucción, prolongando el procedimiento y causando ansiedad y molestia al paciente. Esta cirugía se realiza con anestesia local y sedación complementaria. Dentro de los anestésicos intravenosos la dexmedetomidina es una excelente opción; sin embargo, se han reportado casos de bradicardia severa asociado a inestabilidad hemodinámica y riesgo de complicaciones con su uso. Objetivo: describir la frecuencia de bradicardia con repercusión hemodinámica en pacientes llevados a cirugía micrográfica de Mohs más reconstrucción, bajo anestesia loco regional y sedación con dexmedetomidina. Métodos: estudio observacional descriptivo retrospectivo de 30 pacientes llevados a cirugía de Mohs entre el 1 de noviembre 2012 a 30 de noviembre de 2013. Resultados: el 53,3 % eran mujeres, la edad promedio fue de 68,4 años, 21,4 % fueron clasificados como ASA I, 53,5 % ASA II y 25 % ASA III. El tiempo quirúrgico promedio fue de 184 ± 61 minutos y de anestesia con dexmedetomidina fue 196 ± 65,2 minutos. Solo un paciente requirió atropina durante la cirugía y ningún paciente requirió conversión a anestesia general. Conclusión: la dexmetomidina es una buena alternativa para proporcionar sedación en los pacientes llevados a cirugía de Mohs bajo anestesia loco-regional, debido a su baja incidencia de bradicardia con repercusión hemodinámica y ausencia de la necesidad de soporte ventilatorio.Palabras clave: Cirugía de Mohs; Bradicardia; Anestesia local; Dexmedetomidina; Sedación. AbstractIntroduction: Mohs micrographic surgery is used for the excision of malignant skin tumors and often is followed by reconstruction, prolonging the procedure, causing anxiety and discomfort to the patient. Mohs surgery is performed with local anesthesia and complementary sedation. Among the intravenous anesthetics, Dexmedetomidine is an excellent option; however, there have been reports of severe bradycardia associated with hemodynamic instability and risk of complications with its use. Objective: to describe the frequency of bradycardia with hemodynamic repercussion in patients undergoing Mohs micrographic surgery plus reconstruction, under loco

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Bradycardia leading to asystole during dexmedetomidine infusion in an 18 year-old double-lung transplant recipient

Cited by 40 publications

References 26 publications

Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery

Dexmedetomidine-related atrial standstill and loss of capture in a pediatric patient after congenital heart surgery

Dexmedetomidine for Transport of a Spontaneously Breathing Combative Child

Anestesia loco regional más sedación con dexmedetomidina para cirugía de Mohs con reconstrucción

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