title: Profound reduction in sedation and analgesic requirements using extended dexmedetomidine infusions in a patient with an open abdomen.
abstract: We present a 20-year-old previously healthy male who suffered a gunshot wound to the abdomen and underwent multiple surgeries because of abdominal abscess and fistula formation. Pain control was difficult to achieve despite high-dose opioid therapy. Post-traumatic stress disorder was a confounding factor in treating this patient's pain. Ten months after the original injury, the patient returned to the operating room for an exploratory laparotomy with restoration of bowel continuity and abdominal wall closure. The patient presented to the intensive care unit after a 12-hour operation with an open abdomen and the requirement of mechanical ventilation, sedation, and analgesia. Sedation and analgesia were difficult to achieve and maintain with combinations of extremely high doses of midazolam, lorazepam, propofol, and fentanyl (motor assessment activity scale [MAAS] scores of 5), but profoundly achievable with dexmedetomidine. Dexmedetomidine also improved the patient's mental stability, which resulted in improved patient care through compliance with physicians, nurses, and physical therapists.
authors: Department of Anesthesiology, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
authors: Scott
authors: S
authors: Wallace
authors: Brian
authors: B
authors: Mecklenburg
authors: Steven
authors: S
authors: Hanling
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008889:Military Personnel; D010147:Pain Measurement; D015742:Propofol / Q000008:administration & dosage; D013313:Stress Disorders, Post-Traumatic / Q000150:complications; D014948:Wounds, Gunshot / Q000601:surgery*; D055815:Young Adult
chemical_list: D018712:Analgesics, Non-Narcotic; D020927:Dexmedetomidine; D008140:Lorazepam; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol