Bradycardia resulting in cardiac arrest in a critically ill patient receiving dexmedetomidine

Dexmedetomidine is an alpha-2 agonist sedative and analgesic used in anesthesia practice, and it has become more prevalent in the critically ill patients requiring short-term mechanical ventilation. While dexmedetomidine is known to have minimal effects on respiratory drive, it has been well-documented to cause bradycardia and hypotension, especially in patients with existing comorbidities. We present a patient without cardiovascular comorbidities who was in the surgical ICU under dexmedetomidine sedation. The patient went into asystole cardiac arrest after vagal stimulation. Return of spontaneous circulation was achieved using ACLS protocol. We offer a review of reported cases and make recommendations on the management of similar situations that may arise given the increasing use of dexmedetomidine.