title: An exaggerated hypertensive response to glycopyrrolate therapy for bradycardia associated with high-dose dexmedetomidine.
abstract: At our institution, high-dose i.v. dexmedetomidine is used to provide sedation for pediatric patients undergoing nonpainful radiological imaging studies. Some of these patients exhibit marked bradycardia (more than 20% deviation from the lowest age-adjusted normal values) while maintaining an arterial blood pressure within an acceptable normal range. We report on three cases wherein treatment of dexmedetomidine-induced bradycardia with i.v. glycopyrrolate (5.0 microg/kg) not only resulting in resolution of bradycardia but also resulting in an exaggerated increase of arterial blood pressure.
authors.affiliation: Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA. keira.mason@childrens.harvard.edu
authors.forename: Keira P
authors.initials: KP
authors.lastname: Mason
authors.forename: Steven
authors.initials: S
authors.lastname: Zgleszewski
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Forman
authors.forename: Cynthia
authors.initials: C
authors.lastname: Stark
authors.forename: James A
authors.initials: JA
authors.lastname: DiNardo
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects* / Q000627:therapeutic use*; D000293:Adolescent; D001919:Bradycardia / Q000139:chemically induced* / Q000188:drug therapy* / Q000503:physiopathology; D001932:Brain Neoplasms / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D003398:Craniosynostoses / Q000601:surgery; D020927:Dexmedetomidine / Q000009:adverse effects*; D006024:Glycopyrrolate / Q000009:adverse effects* / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007713:Klinefelter Syndrome / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009456:Neurofibromatosis 1 / Q000601:surgery; D010100:Oxygen / Q000097:blood; D015656:Respiratory Mechanics / Q000187:drug effects; D014402:Tuberous Sclerosis / Q000150:complications / Q000601:surgery
chemical_list: D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D010100:Oxygen; D006024:Glycopyrrolate