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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A 78-year-old male patient receiving chemotherapy for esophageal cancer suddenly lost consciousness and subsequent intensive care was initiated after resuscitation on hospital day 12. Laboratory examination showed an extreme hyperosmotic state (serum sodium concentration：169 mEq/L, blood sugar level：817 mg/dL). Serum osomolarity was corrected within 1 week；however, the patient was still in coma and mechanical ventilation was required. CT demonstrated cerebral infarctions in the posterior lobes and electroencephalogram showed cortical activities. Two months later, the conscious level suddenly improved and spontaneous respiration was observed. MRI findings strongly suggested the development of central pontine myelinolysis. The patient underwent rehabilitation training and was finally moved to a neighboring hospital without mechanical ventilation on hospital day 126.