Acute and Critical Care

Original Article

Pharmacology
Dexmedetomidine Use in Patients with 33℃ Targeted Temperature Management: Focus on Bradycardia as an Adverse Effect: Hyo-yeon Seo, Byoung-joon Oh, Eun-jung Park, Young-gi Min, Sang-cheon Choi; Korean J Crit Care Med. 2015;30(4):272-279. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.272

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Abstract PDF: Background
This study aimed to investigate bradycardia as an adverse effect after administration of dexmedetomidine during 33℃ target temperature management.
Methods
A retrospective study was conducted on patients who underwent 33℃ target temperature management in the emergency department during a 49-month study period. We collected data including age, sex, weight, diagnosis, bradycardia occurrence, target temperature management duration, sedative drug, and several clinical and laboratory results. We conducted logistic regression for an analysis of factors associated with bradycardia.
Results
A total of 68 patients were selected. Among them, 39 (57.4%) showed bradycardia, and 56 (82.4%) were treated with dexmedetomidine. The odds ratio for bradycardia in the carbon monoxide poisoning group compared to the cardiac arrest group and in patients with higher body weight were 7.448 (95% confidence interval [CI] 1.834-30.244, p = 0.005) and 1.058 (95% CI 1.002-1.123, p = 0.044), respectively. In the bradycardia with dexmedetomidine group, the infusion rate of dexmedetomidine was 0.41 ± 0.15 μg/kg/h. Decisions of charged doctor’s were 1) slowing infusion rate and 2) stopping infusion or administering atropine for bradycardia. No cases required cardiac pacing or worsened to asystole.
Conclusions
Despite the frequent occurrence of bradycardia after administration of dexmedetomidine during 33℃ target temperature management, bradycardia was completely recovered after reducing infusion rate or stopping infusion. However, reducing the infusion rate of dexmedetomidine lower than the standard maintenance dose could be necessary to prevent bradycardia from developing in patients with higher body weight or carbon monoxide poisoning during 33℃ targeted temperature management.

Case Report

Cardiac Tamponade Caused by Epigastric Acupuncture: A Case Report: Jong Kun Kim; Korean J Crit Care Med. 2011;26(4):281-284.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.281

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1 Crossref

Acupuncture is considered a relatively safe procedure. However, there are serious adverse effects; neurological damage, pneumothorax, cardiac tamponade, serum hepatitis, bacterial and viral infections may occur. Cardiac tamponade is considered to be a rare adverse effect of acupuncture. In the following case, cardiac tamponade was caused by epigastric acupuncture. A 78-year-old male was admitted with a chief complaint of drowsy mentality and hypotension, suggesting a status of shock. He had received acupuncture therapy over epigastric area for gastric dyspepsia at a local oriental medical clinic. An abdominal CT scan and chest x-ray showed a hemopericardium. After receiving pericardiocentesis, his clinical condition improved immediately. He was short in stature and slender for his age. Chest x-ray and computed tomography showed cardiomegaly and pectus excavatum. A proper use of acupuncture by a skilled medical provider is essential to avoid serious complications.

Citations

Citations to this article as recorded by

A Study on Korean Traditional Medicine Side Effects Cases Described in Domestic Western Medical Journals in the Past 10 Years
Myeong-hwa Lee, Byun-woo Son, Kyoung-min Kim, Soo-hyung Jeon, Young-kyun Kim
The Journal of Internal Korean Medicine.2018; 39(4): 686. CrossRef

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