The Annals of pharmacotherapy
-
To report 3 cases of accidental dexmedetomidine overdose in the perioperative setting and review the pathophysiology of alpha2-agonist overdose. case summaries: Three patients accidentally received overdoses of dexmedetomidine, one intraoperatively (192 microg over 20 min) and 2 postoperatively (4 and 2 rather than 0.4 and 0.2 microg/kg/h; 0.5 microg/kg/min rather than 0.5 microg/kg/h). Hemodynamic parameters remained stable for all 3 patients. The most notable sign was oversedation diagnosed either clinically or using a bispectral index monitor; Naranjo criteria suggest possible or probable association of the reactions with dexmedetomidine. In all 3 cases, oversedation resolved within one hour of drug discontinuation. There were no other sequelae, and the remainder of each patient's hospital course was unremarkable. ⋯ Practitioners presented with dexmedetomidine overdose should be prepared to manage oversedation. While hemodynamic alterations may be seen with dexmedetomidine use, hypertension from high dexmedetomidine plasma concentrations is not a consistent response. Practitioners using dexmedetomidine should carefully note that dosing for this agent is described by the manufacturer in microg/kg/h, not microg/kg/min.