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CASE REPORT

An Exaggerated Hypertensive Response to Glycopyrrolate Therapy for Bradycardia Associated with High-Dose Dexmedetomidine

Keira P. Mason, MD^*, Steven Zgleszewski, MD^*, Roberta E. Forman, RN, Cynthia Stark, PNP, and James A. DiNardo, MD^*

From the Departments of *Anesthesia, Perioperative and Pain Medicine, and Radiology, Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Address correspondence and reprint requests to Keira P. Mason, MD, Department of Anesthesia, Perioperative and Pain Medicine, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115. Address e-mail to keira.mason{at}childrens.harvard.edu.

At our institution, high-dose IV dexmedetomidine is used to provide sedation for pediatric patients undergoing nonpainful radiological imaging studies. Some of these patients exhibit marked bradycardia (more than 20% deviation from the lowest age-adjusted normal values) while maintaining an arterial blood pressure within an acceptable normal range. We report on three cases wherein treatment of dexmedetomidine-induced bradycardia with IV glycopyrrolate (5.0 µg/kg) not only resulting in resolution of bradycardia but also resulting in an exaggerated increase of arterial blood pressure.