[Use of dexmedetomidine in a critically ill patient with hyperactive delirium: a case report]

A 28-year-old male after a traffic accident was hospitalized with the abdominal pain. The abdominal CT showed deep hepatic injury. We immediately performed emergency transcatheter arterial embolization (TAE) and observed him in the ICU. His condition was stable for a while, but soon he became disoriented and restless. We diagnosed him with hyperactive delirium in the ICU and administered flunitrazepam and haloperidol but with no effect. Next, we used dexmedetomidine hydrochloride (DEX), which was effective on delirium. DEX is a potent and highly selective alpha2 adrenoreceptor agonist and has minimal respiratory depression in contrast to other sedatives. During sedation with DEX, it is easy to arouse patients with physiological stimulus. Both memory and cognition are reported to be maintained to a certain degree during sedation with DEX. Postoperative delirium has been reported to be less with DEX compared to other sedatives. Recent studies have revealed that delirium is one of the most frequent complications and an independent risk factor for prognosis in the ICU patients. DEX may be effective for controlling delirium and provide sufficient sedation without respiratory adverse effects in patients in the ICU.