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

• Published in: Journal of anesthesia 2014-02, Vol.28 (1), p.116-120
• Main Authors: Takata, Kotaro, Adachi, Yushi U., Suzuki, Katsumi, Obata, Yukako, Sato, Shigehito, Nishiwaki, Kimitoshi
• Format: Article
• Language: English
• Subjects: Anesthesiology; Atrioventricular Block - chemically induced; Bradycardia - chemically induced; Cardiac arrest; Cardiac Pacing, Artificial; Cardiac Surgical Procedures - methods; Cardiopulmonary Resuscitation - methods; Care and treatment; Case studies; Clinical Report; Complications and side effects; Critical Care Medicine; Dexmedetomidine; Dexmedetomidine - administration & dosage; Dexmedetomidine - adverse effects; Dosage and administration; Electrocardiography; Emergency Medicine; Heart Arrest - chemically induced; Heart block; Humans; Intensive; Male; Medicine; Medicine & Public Health; Middle Aged; Pain Medicine; Risk factors
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-013-1676-7

Sinus bradycardia is a well-known consequence of stimulation of presynaptic α 2 adrenergic receptors due the adminstration of dexmedetomidine. One of the most serious adverse effects of dexmedetomidine is cardiac arrest. Some cases demonstrating such an arrest due to the indiscriminate use of this drug were recently reported. We continuously administered dexmedetomidine to a 56-year-old male patient at a rate of 0.3 μg/kg/h (lower than the recommended dose) without initial dosing for sedation in an intensive care unit. The patient had undergone open cardiac surgery and atrial pacing was maintained at a fixed rate, 90/min. The PQ interval in electrocardiography gradually prolonged during the infusion; finally, complete atrioventricular block and subsequent cardiac arrest occurred. Immediate cardiopulmonary resuscitation was carried out, including re-intubation, and recovery of spontaneous circulation was attained 15 min after the event. The patient was discharged from hospital on the 25th postoperative day without any neurological complications.