Severe Rash Associated with Dexmedetomidine Use During Mechanical Ventilation

Abstract

Dexmedetomidine, a sedative administered by continuous infusion, is used to facilitate mechanical ventilation through alpha(2)-receptor activation. The drug's most common adverse reactions include hypotension, hypertension, nausea, bradycardia, and dry mouth. However, to our knowledge, no reports of dermatologic allergic reactions from dexmedetomidine use have been published. We describe a 22-year-old man who was intubated after being injured in a motor vehicle collision. He had been receiving propofol and fentanyl infusions for sedation during mechanical ventilation and was transitioning to dexmedetomidine. Within 4 hours of receiving dexmedetomidine 0.2 microg/kg/hour, the patient developed a wheal-and-flare rash encompassing 60% of his body surface area. The infusion was immediately discontinued; over the next 24 hours most of the rash receded, and within 48 hours of drug discontinuation the rash had completely resolved. According to the Naranjo adverse drug reaction probability scale, the likelihood that this rash was induced by dexmedetomidine was probable. Clinicians should be aware of this potential dermatologic adverse effect from dexmedetomidine, and patients receiving the drug should be closely monitored.

Cutaneous reaction after intravenous administration of medetomidine?

“…The package leaflet of this drug states that irritation, sensitization and contact dermatitis have been documented only after skin contact. A similar problem has been reported in humans following the use of dexmedetomidine (Ludwig et al. 2009) where a severe rash occurred after starting a dexmedetomidine infusion and was resolved by administration of diphenhydramine and discontinuation of dexmedetomidine infusion.…”

Advances in Anesthesia for Shoulder Surgery: A Comprehensive Review of Dexmedetomidine-Enhanced Interscalene Brachial Plexus Block

“…These reactions may manifest as skin rashes, itching, swelling, or, in severe cases, anaphylaxis. Immediate recognition and prompt treatment of allergic reactions are critical to ensure patient safety [79].…”