Post-operative cardiac arrest induced by co-administration of amiodarone and dexmedetomidine: a case report

Abstract

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.

Dexmedetomidine: present and future directions

“…Although the incidence of severe bradycardia is low, there are some case reports of dexmedetomidine-related cardiac arrest. Cardiac conduction disorders, including left anterior fascicular block [81] and first-degree AV block [82], and the co-administration of amiodarone and dexmedetomidine [83,84] are potential factors contributing to the development of asystole, especially during general or regional anesthesia. In addition, caution should be taken when administering dexmedetomidine to patients with volume depletion or vasoconstriction.…”

Effect of Different Loading Doses of Dexmedetomidine on Controlled Hypotension and the Incidence of Bradycardia During Rhinoplasty: A Clinical Trial

“…The bradycardia associated with IV administration of dexmedetomidine was explained in two phases; the first phase is thought to be vagally mediated reflex bradycardia in response to initial induced hypertension, especially seen in young, healthy patients (48) with high vagal tone (49), and the second phase occurs following the centrally mediated inhibition of sympathetic outflow. (31,33) There are some reports of cardiac arrests following IV infusion of dexmedetomidine, most of which resolved after a few resuscitative efforts (38)(39)(40)(41)(42)(43). However, not all the cases could be attributed to dexmedetomidine alone, as other contributing factors were involved, and most of the reported cases had significant morbidities and/or with some sorts of atrioventricular conduction diseases, though there were reported cases of sinus arrest in young, healthy patients, as well (49).…”

“…Apart from all the benefits, dexmedetomidine also has its drawbacks, the most important of which are severe bradycardia and even, in rare cases, cardiac arrest (38)(39)(40)(41)(42)(43). Since hemodynamic alterations mostly occur during loading infusion (33), the current study was conducted to determine whether, by decreasing the loading dose of dexmedetomidine, the incidence of bradycardia is reduced while the hypotensive effect is preserved.…”

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

“…Two hours after initiating DEX to a patient being treated with amiodarone for tachycardia, cardiac arrest occurred. A review of the ECGs of the patient prior to the event demonstrated ominous atrioventricular abnormalities with DEX [ 46 ].…”