title: Dexmedetomidine use in the ED for control of methamphetamine-induced agitation.
abstract: BACKGROUND
  Chemical restraint is often required to control agitation induced by methamphetamine. Dexmedetomidine is an α-2 adrenergic receptor agonist with sedative, analgesic, and sympatholytic properties. Its use in the emergency department (ED) to control methamphetamine-induced agitation has not been reported.
  
  
  OBJECTIVE
  To report two cases of methamphetamine-induced agitation successfully sedated with dexmedetomidine in the ED.
  
  
  METHODS
  The first case was a 42-year-old man with unstable emotion and violent behaviours after smoking methamphetamine. His agitation did not respond to a large cumulative dose of benzodiazepines (10mg of diazepam and 332mg of midazolam) administered over 48h and sedation was achieved with dexmedetomidine. The second case was a 38-year-old methamphetamine user with unstable emotion and recurrent episodes of agitation despite repeated doses of benzodiazepines, whose agitation was controlled with dexmedetomidine infusion.
  
  
  CONCLUSIONS
  In both cases, dexmedetomidine apparently reduced the dose of benzodiazepines needed to achieve adequate sedation. Transient falls in blood pressure and slowing of the heart rate were noted, which resolved either spontaneously or after reducing the infusion rate without requiring drug treatment.
  
  
  CONCLUSIONS
  Dexmedetomidine can be considered as an adjunct for chemical restraint when standard treatment fails to control the agitation induced by methamphetamine, but patient's hemodynamic state should be monitored closely during administration. Its efficacy and safety in the ED warrant further evaluation with prospective controlled trials.
authors.affiliation: Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 204, 2/F, William MW Mong Block, 21 Sassoon Road, Hong Kong Special Administrative Region, China. Electronic address: lampkrex@hku.hk.
authors.forename: Rex Pui Kin
authors.initials: RPK
authors.lastname: Lam
authors.affiliation: Department of Accident and Emergency, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
authors.forename: Wai Lam
authors.initials: WL
authors.lastname: Yip
authors.affiliation: Department of Accident and Emergency, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
authors.forename: Chi Keung
authors.initials: CK
authors.lastname: Wan
authors.affiliation: Department of Accident and Emergency, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
authors.forename: Matthew Sik Hon
authors.initials: MSH
authors.lastname: Tsui
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects*; D058647:Adrenergic alpha-2 Receptor Agonists / Q000627:therapeutic use*; D000328:Adult; D000342:Affective Symptoms / Q000139:chemically induced / Q000188:drug therapy*; D000374:Aggression; D017109:Akathisia, Drug-Induced / Q000188:drug therapy* / Q000209:etiology; D003221:Confusion / Q000139:chemically induced / Q000188:drug therapy*; D020927:Dexmedetomidine / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*
chemical_list: D018759:Adrenergic Uptake Inhibitors; D058647:Adrenergic alpha-2 Receptor Agonists; D008694:Methamphetamine; D020927:Dexmedetomidine
keywords: Adrenergic alpha-2 receptor agonist; Agitation; Emergency department; Methamphetamine; Sedation