{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T17:53:38Z","timestamp":1777312418916,"version":"3.51.4"},"reference-count":68,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Dexmedetomidine is a highly selective \u03b1\n                    <jats:sub>2-<\/jats:sub>\n                    adrenergic agonist with sedo-analgesic properties. It has been approved by the United States Food and Drug Administration (FDA) for sedation of critically ill patients, facilitation of awake procedures, and management of patient agitation. However, its use has been occasionally associated with adverse effects like bradycardia, hypotension, and asystole. The risk of these effects, particularly cardiac arrest, is increased in the elderly, patients with multiple comorbidities, and administration of higher doses of the drug (especially loading doses). However, perioperative pericardiac arrest with only low-dose dexmedetomidine infusion, in a young healthy male, has not been previously reported.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case Presentation:<\/jats:bold>\n                    We report a 33-year-old male, ASA 1 E, who underwent open reduction and internal fixation of a left ankle fracture under spinal anesthesia. He was sedated intraoperatively with intravenous dexmedetomidine, infused at 0.2 \u03bcg\/kg\/h, without a loading dose. Approximately 90 minutes into the procedure, he had severe bradycardia and hypotension, leading to a peri-arrest situation. He was successfully revived with intravenous atropine and ephedrine and completed the surgery uneventfully.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    We opine that the use of dexmedetomidine as a sedative agent in patients under spinal anesthesia requires heightened caution due to the risk of major adverse cardiac events. Our case exemplifies that this risk persists even in healthy young patients, at low drug infusion rates, and even after avoiding a loading dose.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.117","type":"journal-article","created":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T05:30:25Z","timestamp":1765690225000},"source":"Crossref","is-referenced-by-count":1,"title":["Serious adverse effect of low-dose dexmedetomidine under spinal anesthesia: A case report and literature review"],"prefix":"10.5339","volume":"2025","author":[{"given":"Muhammad Firas","family":"Alhammad","sequence":"first","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Jaffar","family":"Khan","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arunabha","family":"Karmakar","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazim","family":"Kassas","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasser","family":"Hammad","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasir","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamad Talal","family":"Basrak","sequence":"additional","affiliation":[{"name":"Tower Health, West Reading, Pennsylvania, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tarek","family":"Tageldin","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adnan","family":"Alshami","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Intensive and Emergency Medicine, and Pain Management, Helios Klinikum Cuxhaven, Lower Saxony, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nabil","family":"Shallik","sequence":"additional","affiliation":[{"name":"Anaesthesia, ICU and Perioperative Medicine Department, Hamad Medical Corporation, Doha, Qatar"},{"name":"Clinical Anaesthesiology Department, Weill Cornell Medical College in Qatar, Doha, Qatar"},{"name":"Clinical Anaesthesiology Department, College of Medicine, Qatar University, Doha, Qatar"},{"name":"Clinical Anaesthesia and SICU Department, Tanta University, Tanta, Egypt*Correspondance: Muhammad Firas Alhammad malhammad1@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"key":"B1","series-title":"Best Pract Res Clin Anaesthesiol","first-page":"335\u201348","article-title":"Peri-operative cardiovascular morbidity: new developments","volume":"13","author":"Mangano\n \nDT","year":"1999"},{"issue":"(1):","key":"B2","series-title":"Anaesthesia","first-page":"18\u201330","article-title":"Peri-operative cardiac arrest: epidemiology and clinical features of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists","volume":"79","author":"Armstrong\n \nRA","year":"2024"},{"issue":"(1):","key":"B3","series-title":"Anaesthesia","first-page":"31\u201342","article-title":"Peri-operative cardiac arrest: management and outcomes of patients analysed in the 7th National Audit Project of the Royal College of Anaesthetists","volume":"79","author":"Armstrong\n \nRA","year":"2024"},{"issue":"(2):","key":"B4","series-title":"Anesth Analg","first-page":"406\u201312","article-title":"Relationship between intraoperative and preoperative ambulatory nighttime heart rates: a secondary analysis of a prospective observational study","volume":"133","author":"Kouz\n \nK","year":"2021"},{"issue":"(3):","key":"B5","series-title":"Transl Perioper Pain Med","first-page":"55\u201362","article-title":"Is it time for an expanded role of dexmedetomidine in contemporary anesthesia practice? 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II. Hemodynamic changes","volume":"77","author":"Bloor\n \nBC","year":"1992"},{"issue":"(2):","key":"B12","series-title":"Anesth Analg","first-page":"461\u20136","article-title":"The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation","volume":"95","author":"Arain\n \nSR","year":"2002"},{"issue":"(7):","key":"B13","series-title":"Circulation","first-page":"700\u201310","article-title":"Cardiovascular and ventilatory consequences of laparoscopic surgery","volume":"135","author":"Atkinson\n \nTM","year":"2017"},{"issue":"(8):","key":"B14","series-title":"Can J Anaesth","first-page":"783\u20138","article-title":"Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients","volume":"43","author":"Dhoste\n \nK","year":"1996"},{"key":"B15","article-title":"Prescribing information for Dexmedetomidine","author":"U.S. Food and Drug Administration","year":"2021"},{"key":"B16","series-title":"J Clin Anesth","first-page":"13\u20139","article-title":"Anticholinergic premedication to prevent bradycardia in combined spinal anesthesia and dexmedetomidine sedation: a randomized, double-blind, placebo-controlled study","volume":"35","author":"Ahn\n \nEJ","year":"2016"},{"issue":"(2):","key":"B17","series-title":"Br J Anaesth","first-page":"211\u201320","article-title":"Dexmedetomidine pharmacodynamics in healthy volunteers: 2. 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