Posterior Reversible Encephalopathy Syndrome as a Result of Withdrawal from Prolonged Dexmedetomidine

Abstract

Dexmedetomidine is a selective α-adrenergic agonist with high α-2 receptor affinity that is used for sedation, analgesia, and as an anxiolytic. Withdrawal symptoms, although rare, include agitation, irritability, headache, and rebound hypertension, which can occur following abrupt cessation of the medication. Posterior reversible encephalopathy syndrome is a clinical condition presenting secondary to acute hypertension that results in neurologic symptoms including headache, seizures, altered sensorium, and loss of vision. These symptoms are coupled with typically reversible characteristic magnetic resonance imaging changes. We present the first reported case of posterior reversible encephalopathy syndrome after a hypertensive crisis likely precipitated by dexmedetomidine withdrawal.

Keywords

posterior reversible encephalopathy syndrome - dexmedetomidine - withdrawal

• References

• 1 Tobias JD. Dexmedetomidine: are there going to be issues with prolonged administration?. J Pediatr Pharmacol Ther 2010; 15 (1) 4-9
• 2 Buck ML. Dexmedetomidine use in pediatric intensive care and procedural sedation. J Pediatr Pharmacol Ther 2010; 15 (1) 17-29
• 3 Honey BL, Harrison DL, Gormley AK, Johnson PN. Evaluation of adverse events noted in children receiving continuous infusions of dexmedetomidine in the intensive care unit. J Pediatr Pharmacol Ther 2010; 15 (1) 30-37
• 4 Carroll CL, Krieger D, Campbell M, Fisher DG, Comeau LL, Zucker AR. Use of dexmedetomidine for sedation of children hospitalized in the intensive care unit. J Hosp Med 2008; 3 (2) 142-147
• 5 Ozaki M, Takeda J, Tanaka K , et al. Safety and efficacy of dexmedetomidine for long-term sedation in critically ill patients. J Anesth 2014; 28 (1) 38-50
• 6 Weber MD, Thammasitboon S, Rosen DA. Acute discontinuation syndrome from dexmedetomidine after protracted use in a pediatric patient. Paediatr Anaesth 2008; 18 (1) 87-88
• 7 Walker J, Maccallum M, Fischer C, Kopcha R, Saylors R, McCall J. Sedation using dexmedetomidine in pediatric burn patients. J Burn Care Res 2006; 27 (2) 206-210
• 8 Venn M, Newman J, Grounds M. A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit. Intensive Care Med 2003; 29 (2) 201-207
• 9 Miller JL, Allen C, Johnson PN. Neurologic withdrawal symptoms following abrupt discontinuation of a prolonged dexmedetomidine infusion in a child. J Pediatr Pharmacol Ther 2010; 15 (1) 38-42
• 10 Hinchey J, Chaves C, Appignani B , et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996; 334 (8) 494-500
• 11 Chen TH, Lin WC, Tseng YH, Tseng CM, Chang TT, Lin TJ. Posterior reversible encephalopathy syndrome in children: case series and systematic review. J Child Neurol 2013; 28 (11) 1378-1386
• 12 Geevasinga N, Cole C, Herkes GK, Barnett Y, Lin J, Needham M. Sickle cell disease and posterior reversible leukoencephalopathy. J Clin Neurosci 2014; 21 (8) 1329-1332
• 13 Cordelli DM, Masetti R, Ricci E , et al. Life-threatening complications of posterior reversible encephalopathy syndrome in children. Eur J Paediatr Neurol 2014; 18 (5) 632-640