Transient Asystole Linked to Dexmedetomidine Infusion

Abstract

Background: Five adult medical, critically ill patients developed bradycardia leading to asystole while receiving dexmedetomidine infusion. Materials and methods: This is a case series of five adult patients obtained from the medical intensive care unit in a community teaching hospital between May 2019 through August 2020. These patients were each receiving dexmedetomidine infusion while on invasive mechanical ventilation leading to periods of asystole that resolved after stopping dexmedetomidine infusion in all five patients. Results: The five patients were mechanically ventilated while receiving dexmedetomidine infusion and experienced periods of brief asystole triggered by vagal stimulation induced by airways suctioning or coughing. Each episode was resolved without intervention. Despite the presence of confounding factors, such as other sedatives and chronotropic medications, it was concluded the main reason for the potentiated vagal response was the presence of dexmedetomidine infusion. Conclusions: The routine use of continued infusion of dexmedetomidine can lead to asystole if instigated by common vagal stimulation of the trachea during mechanical ventilation.