Journal of Clinical Anesthesia
Volume 22, Issue 1 , Pages 45-49, February 2010

Bradycardia leading to asystole during dexmedetomidine infusion in an 18 year-old double-lung transplant recipient

  • Xiaopeng Zhang, MD, PhD (Staff Anesthesiologist)

      Affiliations

    • Division of Anesthesiology, Geisinger Medical Center, Danville, PA 17821, USA
    • ,
  • Ulrich Schmidt, MD, PhD (Assistant Professor)

      Affiliations

    • Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
    • ,
  • John C. Wain, MD (Assistant Professor)

      Affiliations

    • Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
    • ,
  • Luca Bigatello, MD (Associate Professor)

      Affiliations

    • Anesthesia and Critical Care Service, V.A. Boston Healthcare System, Boston, MA 02132, USA
    • Corresponding Author InformationCorresponding author. Department of Anesthesia and Critical Care Service, VA Boston Healthcare Center, 1400 VFW Parkway, West Roxbury, MA 02132, USA.

Received 23 November 2008; received in revised form 11 June 2009; accepted 24 June 2009.

Abstract 

The case of an 18 year-old double-lung transplant recipient recovering from acute respiratory distress syndrome who developed repeated episodes of bradycardia and asystole (maximum duration: 10 sec) during dexmedetomidine administration is presented. Increased baseline vagal tone, paroxysmal coughing spells, and opioid administration were likely contributors to the episodes. Discontinuation of the drug restored regular sinus rhythm. Double-lung transplant recipients may be at especially increased risk for this phenomenon as a result of changes in the autonomic innervation of the heart.

Keywords: Asystole, Bradycardia, Dexmedetomidine infusion, Double lung transplantation

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PII: S0952-8180(09)00344-4

doi:10.1016/j.jclinane.2009.06.002

Journal of Clinical Anesthesia
Volume 22, Issue 1 , Pages 45-49, February 2010

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