KMID : 1141320230380010050
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Kosin Medical Journal 2023 Volume.38 No. 1 p.50 ~ p.55
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Development of severe junctional bradycardia after dexmedetomidine infusion in a polypharmacy patient: a case report and literature review
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Jeon So-Eun
Kim Eun-Soo Lee Sun-Hack Paek Sung-In Ri Hyun-Su Lee Do-Won
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Abstract
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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.
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KEYWORD
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Anesthesia, spinal, Bradycardia, Case reports, Dexmedetomidine, Polypharmacy
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