Hemodynamic instability following intravenous dexmedetomidine infusion for sedation under brachial plexus block: Two case reports

BACKGROUND: Dexmedetomidine (DMED) is frequently used as a sedative in several medical fields. The benefits of DMED include enhanced quality of regional anesthesia, prolonged analgesia, and postoperative opioid-sparing when administered intravenously or perineurally in combination with regional anesthesia. Severe hemodynamic complications, such as profound bradycardia and hypotension, can occur after DMED administration in critically ill patients or overdosage; however, there are few reports of complications with DMED administration following brachial plexus block (BPB). CASE SUMMARY: We present two cases of hemodynamic instability that occurred following the initial loading of DMED under supraclavicular BPB. A healthy 29-year-old man without any medical history showed profound bradycardia after receiving a loading dose of DMED 0.9 μg/kg for 9 min. DMED administration was promptly stopped, and after receiving a second dose of atropine, the heart rate recovered. A 62-year-old woman with a history of cardiomyopathy became hypotensive abruptly, requiring the administration of inotrope and vasopressors after receiving a reduced loading dose of 0.5 μg/kg for 10 min. Half of the recommended loading dose of DMED was administered due to the underlying heart dysfunction. Decreased blood pressure was maintained despite the intravenous administration of ephedrine. With continuous infusion of dopamine and norepinephrine, the vital signs were maintained within normal ranges. Inotropic and vasopressor support was required for over 6 h after the initial loading dose of DMED. CONCLUSION: DMED administration following BPB could trigger hemodynamic instability in patients with decreased cardiac function as well as in healthy individuals.