Kosin Med J.  2023 Mar;38(1):50-55. 10.7180/kmj.22.113.

Development of severe junctional bradycardia after dexmedetomidine infusion in a polypharmacy patient: a case report and literature review

• Jeon S
• Kim E
• Lee SH
• Paek SI
• Ri HS
• Lee D

• KMID: 2540762
• DOI: http://doi.org/10.7180/kmj.22.113

Abstract

The authors report a case of newly manifested severe junctional bradycardia following dexmedetomidine administration during spinal anesthesia in a polypharmacy patient. A 77-year-old woman receiving multiple medications, including a beta-blocker and a calcium channel blocker, underwent right total knee arthroplasty. After spinal anesthesia, intravenous dexmedetomidine was initiated as a sedative; her heart rate decreased, followed by junctional bradycardia (heart rate, 37–41 beats/min). Dexmedetomidine was discontinued, and a dopamine infusion was initiated. Seven hours after surgery, junctional bradycardia persisted; a temporary transvenous pacemaker was inserted, and the beta-blocker and calcium channel blocker were discontinued. The patient was discharged on postoperative day 11 without any sequelae. Anesthesiologists should be aware of dexmedetomidine’s inhibitory effects on the cardiac conduction system, especially in geriatric patients taking medications with negative chronotropic effects and in combination with neuraxial anesthesia.

Keyword

Anesthesia, spinal; Bradycardia; Case reposts; Complication; Dexmedetomidine; Polypharmacy

Figure

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  Fig. 1. Electrocardiogram. (A) Pre-operation (HR 50 beats/min). (B) Operative day (HR 30 beats/min). (C) POD 1 (HR 60 beats/min; temporary pacemaker inserted). (D) POD 2 (HR 60 beats/min; temporary pacemaker inserted). (E) POD 3 (HR 55 beats/min; temporary pacemaker inserted). (F) POD 4 (HR 53 beats/min; temporary pacemaker inserted). HR, heart rate; POD, postoperative day.

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  Fig. 2. Vital signs and drugs used during the operation. Drugs and events: (1) spinal anesthesia was performed, (2) femoral nerve catheterization was performed and dexmedetomidine administration was started, (3) atropine (500 μg, intravenously), (4) junctional rhythm with hidden P waves was observed, (5) dopamine infusion was initiated and dexmedetomidine was discontinued, (6) severe bradycardia and junctional rhythm recurred and a dobutamine infusion was initiated, (7) the dobutamine infusion was terminated. HR, heart rate; MBP, mean blood pressure; SpO2, oxygen saturation; RR, respiratory rate.

Reference

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