Dexmedetomidine-induced atrioventricular block followed by cardiac arrest during atrial pacing: a case report and review of the literature

Takata, Kazuhide; Adachi, Yushi; Suzuki, Koji; Obata, Yukako; Sato, Shigehito; Nishiwaki, Kimitoshi

doi:10.1007/s00540-013-1676-7

Cited by 25 publications

(24 citation statements)

References 12 publications

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“…Dexmedetomidine-induced cardiovascular effects are usually characterized by lowered heart rate and blood pressure [2, 3]. While cases of bradycardia or asystole under dexmedetomidine have been documented [4], asystole has been perpetuated by either the coexistence of factors like spinal anesthesia [4] or increased doses [5]. Moreover, little is known about the interaction of dexmedetomidine with other medications.…”

Section: Introductionmentioning

confidence: 99%

Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery

Amaniti

Dalakakis

Gkinas

et al. 2018

Case Reports in Anesthesiology

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Dexmedetomidine is an elective alpha-2 adrenergic agonist, being used in anesthesia practice. It offers sedative, anxiolytic, analgesic, muscle relaxant, and sympathetic lytic properties. While respiratory effects are considered minor, there are important cardiovascular side effects with bradycardia and hypotension being the most common. This article presents a case of a patient, with significant comorbidities and polypharmacy, who was scheduled for cataract surgery under dexmedetomidine sedation. During the administration, severe hemodynamic deterioration was observed with bradycardia and hypotension leading to asystole. Cardiac arrest was successfully managed in accordance with the guidelines of the European Resuscitation Council. Despite the promising role of dexmedetomidine in anesthesia practice, the associated adverse effects cannot be ignored. For this reason it is obligatory to have the minimum mandatory monitoring in accordance with the safety and quality guidelines.

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Section: Introductionmentioning

confidence: 99%

Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery

Amaniti

Dalakakis

Gkinas

et al. 2018

Case Reports in Anesthesiology

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“…A previous study demonstrated that DEX has the function of bidirectional regulation of the cardiovascular system (27). DEX initially agonizes the α 2B receptor of the postsynaptic membrane of the vascular smooth muscle to induce tachycardia and hypertension via vascular constriction.…”

Section: Time Of Drugmentioning

confidence: 99%

Effects of different doses of dexmedetomidine on heart rate and blood pressure in intensive care unit patients

Zhang

Wang

Lü

et al. 2015

Experimental and Therapeutic Medicine

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The aim of the present study was to observe and compare the sedative effect of different doses of DEX on heart rate (HR) and blood pressure (BP) in critically ill patients admitted to intensive care units (ICUs). The study included patients that were retained in ICUs and required sedation between January and March 2014. Patients were excluded if they had a BP of >200 mmHg, a HR of <60 bpm or were in a state of shock. The included patients were randomized into three groups: Group A, 1.0 µg/kg/10 min DEX; group B, 0.5 µg/kg/10 min DEX; and group C, 0.4 µg/kg/h DEX. After receiving these initial designated doses of DEX via an intravenous (IV) infusion pump for 10 min, the patients were maintained continuously at an identical dose of 0.4 µg/kg/h DEX. Ramsay score, HR, systolic blood pressure (SBP), diastolic blood pressure (DBP), breathing rate (BR) and peripheral capillary oxygen saturation (SpO) were recorded prior to the IV pump infusion and at 2, 4, 6, 8, 10, 60, 120, 180 and 240 min following infusion. Patients in groups A and B achieved sedation more rapidly compared with those in group C (P<0.05). HR decreased more significantly at 8 and 60 min after the initial IV pump infusion with DEX in groups A and B compared with group C (P<0.05). SBP decreased significantly at 10 min after IV pump infusion in group A compared with groups B and C (P<0.05). No significant difference existed in the SBP reduction trend between the three groups during the maintenance period. Therefore, the routine dose of DEX (0.4 µg/kg/h) provides an ideal sedative effect in ICU patients. The recommended loading dose for a more rapid sedation is 0.5 µg/kg/h. High loading doses of DEX via IV pump infusion should be avoided in elderly individuals, patients with acute exacerbation of chronic obstructive pulmonary disease and anemic patients, in whom combination medication, such as midazolam or propofol, may be considered when necessary.

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“…The additive or synergistic interaction on the impulse conduction was strongly suspected for the etiology of cardiac arrest. The preoperative electrocardiogram of the patient showed conduction abnormality, e.g., complete right bundle branch block with left anterior fascicle block, and the conduction dysfunction might be a risk factor for administration of the drugs [ 5 ]. We should pay more attention to the possibility of bradycardia; however, the heart rate of the patient showed a consistent tendency of tachycardia before the event.…”

Section: Case Presentationmentioning

confidence: 99%

“…Dexmedetomidine decreases heart rate. An incidence of severe bradycardia might be rare [ 13 , 14 ]; however, we suspect that some of the cases with atrioventricular block induced by the administration of dexmedetomidine were overlooked [ 5 , 15 ]. Moderate bradycardia with atrioventricular block would be misdiagnosed as a slow sinus rhythm in bipolar electrocardiography monitoring [ 16 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Recently, the application of dexmedetomidine in clinical settings is expanding in Japan and in western countries [ 1 ]. However, we previously reported that dexmedetomidine showed a fatal cardiovascular complication including cardiac arrest and reviewed the literature [ 5 ]. Now, we firstly present another patient who developed severe bradycardia followed by cardiac arrest induced by the co-administration of amiodarone and dexmedetomidine.…”

Section: Introductionmentioning

confidence: 99%

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Post-operative cardiac arrest induced by co-administration of amiodarone and dexmedetomidine: a case report

et al. 2015

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We firstly report a postoperative hemodialysis patient who was co-administered with amiodarone and dexmedetomidine and developed severe bradycardia followed by cardiac arrest. A 79-year-old male patient underwent an amputation of the right lower extremity. The electrocardiogram of the patient showed a complete right bundle branch block with left anterior fascicular block before the anesthesia, and paroxysmal atrial tachycardia over 200 beats/min lasting 15 min was observed during surgery. After admission to the intensive care unit, the intensivist and the consultant cardiologist decided to treat tachycardia using amiodarone. The initial dosing of amiodarone and the maintenance infusion succeeded to decrease the heart rate. Approximately 2 h and a half after the start of dexmedetomidine infusion for sedation, the heart rate gradually declined and severe bradycardia suddenly followed by cardiac arrest was observed. Resuscitation was promptly initiated and the patient regained sinus rhythm without delay. In retrospective analysis, the monitoring record of the electrocardiogram revealed the marked atrioventricular conduction abnormalities. This is the first case report concerning a cardiac arrest induced by amiodarone and dexmedetomidine.

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Dexmedetomidine-induced atrioventricular block followed by cardiac arrest during atrial pacing: a case report and review of the literature

Cited by 25 publications

References 12 publications

Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery

Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery

Effects of different doses of dexmedetomidine on heart rate and blood pressure in intensive care unit patients

Post-operative cardiac arrest induced by co-administration of amiodarone and dexmedetomidine: a case report

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