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Dexmedetomidine-Associated Hyperthermia: A Series of 9 Cases and a Review of the Literature

Krüger, Bernard, D., MD*; Kurmann, Judith, MM*; Corti, Natascia, MD; Spahn, Donat, R., MD*; Bettex, Dominique, MD*; Rudiger, Alain, MD*

doi: 10.1213/ANE.0000000000002353
Anesthetic Clinical Pharmacology: Brief Report

Dexmedetomidine, an α2-adrenergic agonist, can be used to perform mild to moderate sedation in critically ill patients. In this case series, 9 cardiovascular intensive care unit patients with hyperthermia during dexmedetomidine administration, suggestive of drug fever, are presented. Hyperthermia (>38.5°C) occurred 6 (4–10) hours (median [interquartile range]) after dexmedetomidine initiation at a dose of 1.0 (0.8–1.3) μg/kg/h and was resolved 3 (1–8) hours after discontinuation of dexmedetomidine. All patients were screened for infectious and noninfectious causes of hyperthermia, and the findings were analyzed by 2 adverse drug reaction (ADR) assessment methods—the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) Causality Assessment and the Naranjo ADR scale. This resulted in a “probable” ADR in all 9 patients (WHO) and a “probable” and “possible” ADR in 1 and 8 patients (Naranjo), respectively. This case series supports published case reports, suggesting that dexmedetomidine administration may be associated with the occurrence of clinically relevant hyperthermia. The underlying mechanisms and risk factors are uncertain and require further research.

Published ahead of print July 28, 2017.

From the *Intensive Care Unit for Cardiovascular Surgery, Institute of Anaesthesiology, University of Zurich, and University Hospital Zurich, Zurich, Switzerland

Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland.

Published ahead of print July 28, 2017.

Accepted for publication June 9, 2017.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

B. D. Krüger and J. Kurmann are equally contributing first authors.

D. Bettex and A. Rudiger are equally contributing last authors.

All investigators met all 4 criteria for authorship according to the recommendations of the International Committee of Medical Journal Editors (ICMJE).

Reprints will not be available from the authors.

Address correspondence to Alain Rudiger, MD, Cardio-surgical Intensive Care Unit, Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. Address e-mail to alain.rudiger@usz.ch.

© 2017 International Anesthesia Research Society
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