Objective: To describe the development of bradycardia during sedation with dexmedetomidine in a patient concurrently receiving digoxin.
Design: Case report.
Setting: The pediatric intensive care unit of a tertiary care children's hospital.
Patients: A 5-wk-old infant with an atrioventricular septal defect requiring sedation during mechanical ventilation for acute respiratory syncytial virus infection.
Measurements and main results: As part of an ongoing evaluation of dexmedetomidine for sedation in the pediatric intensive care unit, the patient received a loading dose (0.5 microg/kg) followed by an infusion (0.44 microg x kg(-1) x hr(-1)) of dexmedetomidine. Sedation assessments and hemodynamic data were collected at least every 2 hrs. During the loading dose, the patient's heart rate decreased from 133 beats/min per min to 116 beats/min. During the ensuing 13 hrs, the heart rate continued to decrease into the mid 90s, with additional episodes of bradycardia into the 40s and 50s. Within 1 hr of discontinuation of the dexmedetomidine infusion, the baseline heart rate had recovered, and no further episodes of acute bradycardia were noted.
Conclusions: This case adds to the limited data regarding dexmedetomidine in pediatric critical care and suggests that caution should be used when considering sedation with dexmedetomidine in patients also receiving digoxin.