Abstract
Dexmedetomidine is an α 2-receptor agonist commonly used for sedation and analgesia in ICU patients. Dexmedetomidine is known to provide sympatholysis and also to have direct atrioventricular and sinoatrial node inhibitory effects. In rare instances, orthotopic lung transplantation has been associated with disruption of autonomic innervation of the heart. The combination of this autonomic disruption and dexmedetomidine may be associated with severe bradycardia and/or asystole. Since orthotopic lung transplant patients with parasympathetic denervation will not respond with increased heart rate to anticholinergic therapy, bradyarrhythmias must be recognized and promptly treated with direct acting beta agonists to avoid asystolic cardiac events.
Highlights
Bradycardia and asystole in the cardiothoracic intensive care unit (CTICU) setting can be due to a broad range of etiologies
We report a case of severe bradycardia leading to asystole after a bilateral orthotopic lung transplantation (OLT) in a patient receiving dexmedetomidine sedation
Dexmedetomidine, a D-enantiomer of medetomidine, is a highly selective agonist of G-protein-coupled α2-adrenergic receptors. These receptors are further categorized into three main subtypes which exist in the periphery (α2A), brain, and spinal cord (α2B, α2C) [2, 3]
Summary
Bradycardia and asystole in the cardiothoracic intensive care unit (CTICU) setting can be due to a broad range of etiologies. Certain patients may be more predisposed to bradyarrhythmias and/or asystole due to a combination of factors such as the surgical procedure, medications being administered, and preexisting patient comorbidities. We report a case of severe bradycardia leading to asystole after a bilateral orthotopic lung transplantation (OLT) in a patient receiving dexmedetomidine sedation. We consider the possibility that cardiac sympathetic denervation secondary to the OLT in conjunction with atrial-ventricular node conduction delay caused by the dexmedetomidine may have led to the asystolic event
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