Dexmedetomidine infusion overdose during anesthesia: A case report.

Area of Science:

• Anesthesiology
• Pediatric Critical Care
• Pharmacology

Background:

• Dexmedetomidine is an alpha-2 adrenergic agonist used for procedural sedation and as an adjunct in general anesthesia.
• Standard dexmedetomidine infusion rates are typically in the micrograms per kilogram per hour (µg kg⁻¹ h⁻¹) range.
• The use of dexmedetomidine in pediatric anesthesia requires careful dose titration due to potential cardiovascular effects.

Observation:

• An intravenous dexmedetomidine infusion of 0.2 µg kg⁻¹ min⁻¹ was administered to a 12-kg infant during general anesthesia.
• A 60-fold increase in the dexmedetomidine infusion rate was observed.
• This dose escalation resulted in a biphasic cardiovascular response.

Findings:

• The initial response to the increased dexmedetomidine infusion rate was hypertension.
• This was followed by significant bradycardia and hypotension, necessitating inotropic support.
• No adverse postoperative or long-term sequelae were identified in the infant.

Implications:

• This case highlights the potential for significant cardiovascular events with supratherapeutic dexmedetomidine dosing in pediatric patients.
• It underscores the importance of precise dose calculation and monitoring during dexmedetomidine administration, especially in infants.
• Understanding the biphasic cardiovascular effects of dexmedetomidine is crucial for managing anesthetic adjuncts in pediatric populations.