Dexmedetomidine for the treatment of paroxysmal autonomic instability with dystonia.
BACKGROUND
A 38-year-old man with severe head trauma complicated by paroxysmal severe intracranial pressure elevation associated with tachypnea, tachycardia, diaphoresis, and extensor posturing was diagnosed as suffering from paroxysmal autonomic instability with dystonia (PAID). These events were unresponsive to standard medical therapy, which included morphine, fentanyl, labetalol, lorazepam, metoprolol, and clonidine.


METHODS
A trial treatment with dexmedetomidine, a central acting alpha2-agonist, to control symptoms of PAID was initiated 12 days after injury. PAID-related events subsided during the 72-h infusion protocol of 0.2-0.7 mcg/kg/h. No further events were noted after termination of the 72-h infusion.


CONCLUSIONS
Dexmedetomidine may be a novel pharmacologic agent to aid in abrogating PAID.
Goddeau
Richard P
RP
Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
Silverman
Scott B
SB
Sims
John R
JR
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology; D001930:Brain Injuries / Q000150:complications* / Q000188:drug therapy; D020927:Dexmedetomidine / Q000627:therapeutic use*; D004421:Dystonia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male
D000316:Adrenergic alpha-Agonists; D020927:Dexmedetomidine