Bradycardia resulting in cardiac arrest in a critically ill patient receiving dexmedetomidine

Abstract

Dexmedetomidine is an alpha-2 agonist sedative and analgesic used in anesthesia practice, and it has become more prevalent in the critically ill patients requiring short-term mechanical ventilation. While dexmedetomidine is known to have minimal effects on respiratory drive, it has been well-documented to cause bradycardia and hypotension, especially in patients with existing comorbidities. We present a patient without cardiovascular comorbidities who was in the surgical ICU under dexmedetomidine sedation. The patient went into asystole cardiac arrest after vagal stimulation. Return of spontaneous circulation was achieved using ACLS protocol. We offer a review of reported cases and make recommendations on the management of similar situations that may arise given the increasing use of dexmedetomidine.

Evaluation of the Relationship between Baseline Autonomic Tone and Haemodynamic Effects of Dexmedetomidine

“…However, despite its desirable effects on ICU population, the dexmedetomidine sympatholytic effect can even lead to cardiac arrest in ICU patients without cardiovascular comorbidities, just after vagal stimulation, as described in a report by Bahraini et al [ 30 ].…”

Hemodynamic instability following intravenous dexmedetomidine infusion for sedation under brachial plexus block: Two case reports

“…There have been several reports of severe bradycardia with or without asystole related to DMED under general anesthesia[ 10 , 11 ] in pediatric[ 8 ], the elderly, and chronically ill patients[ 5 ]. Moreover, underlying cardiac arrhythmias, such as conduction disorders[ 12 , 13 ] and concurrent parasympathetic activation by spinal anesthesia[ 13 ], could contribute to their development.…”

“…The cardiovascular side effects of DMED, a dose-dependent transient increase in blood pressure (BP) followed by hypotension and bradycardia due to activation of the peripheral α2-adrenergic receptor, are well understood[ 4 ]. Severe hemodynamic complications, such as profound bradycardia or asystole, might occur following DMED administration in critically ill patients[ 5 ] or overdose of the drug[ 6 ]; however, these complications have not been reported in the clinical setting with the conventional regimen of DMED under brachial plexus block (BPB). In this case series, we report two cases of profound bradycardia and refractory hypotension following the administration of the initial loading dose of DMED under BPB for orthopedic upper-extremity surgery.…”