• Rex Pui Kin Lam, Wai Lam Yip, Chi Keung Wan, and Matthew Sik Hon Tsui.
• Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 204, 2/F, William MW Mong Block, 21 Sassoon Road, Hong Kong Special Administrative Region, China. Electronic address: lampkrex@hku.hk.
• Am J Emerg Med. 2017 Apr 1; 35 (4): 665.e1-665.e4.

BackgroundChemical restraint is often required to control agitation induced by methamphetamine. Dexmedetomidine is an α-2 adrenergic receptor agonist with sedative, analgesic, and sympatholytic properties. Its use in the emergency department (ED) to control methamphetamine-induced agitation has not been reported.ObjectiveTo report two cases of methamphetamine-induced agitation successfully sedated with dexmedetomidine in the ED.Case ReportThe first case was a 42-year-old man with unstable emotion and violent behaviours after smoking methamphetamine. His agitation did not respond to a large cumulative dose of benzodiazepines (10mg of diazepam and 332mg of midazolam) administered over 48h and sedation was achieved with dexmedetomidine. The second case was a 38-year-old methamphetamine user with unstable emotion and recurrent episodes of agitation despite repeated doses of benzodiazepines, whose agitation was controlled with dexmedetomidine infusion.DiscussionIn both cases, dexmedetomidine apparently reduced the dose of benzodiazepines needed to achieve adequate sedation. Transient falls in blood pressure and slowing of the heart rate were noted, which resolved either spontaneously or after reducing the infusion rate without requiring drug treatment.ConclusionDexmedetomidine can be considered as an adjunct for chemical restraint when standard treatment fails to control the agitation induced by methamphetamine, but patient's hemodynamic state should be monitored closely during administration. Its efficacy and safety in the ED warrant further evaluation with prospective controlled trials.Copyright © 2016 Elsevier Inc. All rights reserved.

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