Dexmedetomidine-associated fever has been reported in the literature and can lead to lengthy workups and unnecessary antibiotic exposure We conducted a systematic review to evaluate and describe the evidence of fever or hyperthermia caused by dexmedetomidine in adult patients Data sources included PubMed/MEDLINE, EMBASE, CINAHL, and Web of Sciences English-language studies of any design published from inception through April 2020 including conference abstracts were included The target population was hospitalized adult patients Quality of evidence was determined based on GRADE recommendations and risk of bias assessed using the Evidence Project Risk of Bias tool Naranjo scores were assessed to determine the likeliness of adverse event being caused by dexmedetomidine All data were extracted independently and with the guidance of a medical librarian Four hundred and eighty-eight total citations were found on formal search, with 329 left after removal of duplicates Independent record screening was performed, leaving 17 citations including 4 retrospective cohort studies, 1 case series, and 12 case reports Quality of evidence ranged from very low to low for identified analyses Evidence with patient-level data (case reports and series) were combined to establish a cohort for descriptive results The median Naranjo score was 4 (range, 3 to 8), and dexmedetomidine doses ranged from 01 to 2 μg·h/kg Obesity and cardiac surgery appear to be significant risk factors Dexmedetomidine-associated fever appears uncommon, but the true incidence is unknown Clinicians should keep dexmedetomidine-associated fever in their differential, and stewardship programs should consider assessing for this adverse effect in their patient monitoring

Fever Associated With Dexmedetomidine in Adult Acute Care Patients: A Systematic Review of the Literature

心臓手術後の術後せん妄発症率は他の手術と比較して高く，人工心肺の使用および術後ICU管理などの特殊性を有する．術後せん妄の発症には脳内神経炎症が関連することが示唆されているが，治療方法はいまだ確立されていない．麻酔科医としてまず行うべき術後せん妄対策は疼痛コントロールであるが，術前のせん妄ハイリスク患者の同定と共有，術中の脳梗塞予防のための塞栓症対策および麻酔深度モニターの検討，術後の鎮静管理など，周術期を通した継続的な対策を講じることが重要である．心臓手術の低侵襲化により，これまで以上に高齢あるいはハイリスクな患者の心臓麻酔が増加し，術後せん妄対策の重要性はさらに高まると推察される．術後せん妄は，麻酔科医が認知および生命予後に関わる重大な術後合併症であり，麻酔科医を中心とした多職種連携が求められている． 

/pdf/strategies-for-postoperative-delirium-after-cardiac-surgery-2bb5yxya.pdf

Strategies for Postoperative Delirium after Cardiac Surgery

Evaluation of dexmedetomidine withdrawal in critically ill adults.

Learning Objectives: DEX is an α-2 receptor agonist commonly administered as a continuous infusion for sedation in critically ill patients. Guidelines recommend the use of nonbenzodiazepine agents for their lighter sedative effect, decreased incidence of delirium and better safety profiles. The most common adverse effects seen with DEX are hypotension and bradycardia. More recently, pyrexia has been reported, and we describe a case of unexplained fever in a patient receiving DEX. Methods: A 61-year-old male with a history of pulmonary embolism on chronic anticoagulation was admitted to the Intensive Care Unit (ICU) with respiratory failure requiring invasive mechanical ventilation (MV) in the setting of an acute gastrointestinal (GI) bleed and shock. Initial choice of analgosedation included fentanyl and propofol. He was resuscitated with fluids and placed on empiric broad spectrum antibiotics for possible sepsis, though initial evaluation was not notable for a fever. On day 2, he was hemodynamically stable and had slow resolution of GI bleed. Due to an elevated triglyceride level (927 mg/dL), propofol was changed to DEX. A rate of 0.5 mcg/kg/hr was initiated and eventually titrated up to 1.5 mcg/kg/hr based on the actual body weight (190.5 kg). The first fever of 38.2°C was reported 4 hours after initiation of DEX. The patient remained critically ill with intermittent hypotension and fever that precluded extubation. All microbiologic data and diagnostic radiographic testing were unrevealing, and causes of non-infectious etiologies of fever were investigated. On day 4, the patient remained febrile with a maximum temperature of 40°C despite the escalation of antibiotics. At this point, the decision was made to wean DEX and trial extubation. After extubation, the DEX infusion was weaned off resulting in a down trending fever curve which ultimately resolved. The Naranjo Scale was elevated at 8, suggesting a “probable” likelihood of this being an adverse drug event. Results: Fever of unexplained origin in the ICU triggers orders for cultures, imaging and antibiotics and in this case, also increased length of MV. Since dosing of this agent is traditionally weightbased, obese patients who may be receiving high doses can potentially be at an increased risk for any drug-related adverse events.

Katarzyna Adamczyk

Papers

Evaluation of dexmedetomidine withdrawal in critically ill adults.

933: dexmedetomidine-induced fever in a morbidly obese critically ill patient