Dexmedetomidine as a sole sedating agent with local anesthesia in a high-risk patient for axillofemoral bypass graft: a case report

The alpha2-agonist dexmedetomidine is indicated for sedation of patients receiving mechanical ventilation in the intensive care unit. It has additional off-label uses for coadministration with local, regional, and general anesthesia. This report describes the use of dexmedetomidine as a sole sedating agent in conjunction with local anesthesia for major vascular surgery. A PubMed literature search produced no previous report of the use of dexmedetomidine as a sole sedating agent used in conjunction with local anesthesia. The anxiolytic, hypnotic-sedative, anesthetic-sparing, and analgesic actions of the drug along with the lack of significant respiratory depressant effects are described. The patient required no airway management with the exception of supplemental mask oxygen. He tolerated the procedure well and was discharged without sequelae on the third postoperative day. Dexmedetomidine should be used judiciously, and understanding the potential adverse effects and how to treat them is of paramount importance. However, with vigilant intraoperative monitoring of blood pressure, heart rate, and level of consciousness, it can be administered safely, thus lessening the anesthetic requirements and possibly improving the surgical outcome of the high-risk patient. This report describes the indications, dosing, off-label uses, pharmacodynamics, pharmacokinetics, and common adverse effects of dexmedetomidine.