title: Severe rash associated with dexmedetomidine use during mechanical ventilation.
abstract: Dexmedetomidine, a sedative administered by continuous infusion, is used to facilitate mechanical ventilation through alpha(2)-receptor activation. The drug's most common adverse reactions include hypotension, hypertension, nausea, bradycardia, and dry mouth. However, to our knowledge, no reports of dermatologic allergic reactions from dexmedetomidine use have been published. We describe a 22-year-old man who was intubated after being injured in a motor vehicle collision. He had been receiving propofol and fentanyl infusions for sedation during mechanical ventilation and was transitioning to dexmedetomidine. Within 4 hours of receiving dexmedetomidine 0.2 microg/kg/hour, the patient developed a wheal-and-flare rash encompassing 60% of his body surface area. The infusion was immediately discontinued; over the next 24 hours most of the rash receded, and within 48 hours of drug discontinuation the rash had completely resolved. According to the Naranjo adverse drug reaction probability scale, the likelihood that this rash was induced by dexmedetomidine was probable. Clinicians should be aware of this potential dermatologic adverse effect from dexmedetomidine, and patients receiving the drug should be closely monitored.
authors.affiliation: Department of Pharmacy Services, University of Utah Hospitals and Clinics, Salt Lake City, Utah 84132, USA. kyle.ludwig@hsc.utah.edu
authors.forename: Kyle
authors.initials: K
authors.lastname: Ludwig
authors.forename: Matthew
authors.initials: M
authors.lastname: Sorrell
authors.forename: Peter
authors.initials: P
authors.lastname: Liu