Iirola et al. Journal of Medical Case Reports 2010, 4:73 http://www.jmedicalcasereports.com/content/4/1/73 mechanical ventilation and other treatment procedures. Propofol sedation was continued until the 36th post- operative day. Upon the decision of weaning, her attend- ing physician decided to add dexmedetomidine infusion into the sedation regimen 17 days after her surgery. Weaning was not successful, and tracheostomy was per- formed on the 18th postoperative day. On the 19th post- operative day, esophagogastroduodenoscopy and explorative laparotomy were performed because the gen- eral condition of our patient again started to deteriorate. Hemorrhagic pancreatitis with severe inflammation of her abdominal cavity was discovered. This deterioration pre- vented further weaning. Our aim was to stop propofol infusion after starting her on dexmedetomidine, but in order to achieve the desired level of sedation (light to moderate, Sedation-Agitation Scale (SAS) levels 3 to 4 [1]), propofol infusion had to be continued despite the already high dose of dexmedetomidine she was receiving. Our patient later required yet another laparotomy because of elevated abdominal pressure. This surgery did not reveal any additional findings, but this time her abdominal wall had to be left open, and sedation had to be continued. Vacuum-assisted closure therapy was estab- lished on the 22nd and continued until the 34th post- operative day. Weaning was started again on the 36th postoperative day. Clonidine infusion was started on the 40th postoperative day, while the dexmedetomidine infu- sion was discontinued on the following day, on the 24th day of its administration. Page 2 of 5 Our patient’s abdominal wall was finally closed on the 47th day, and the clonidine infusion was stopped on the 51st postoperative day. The tracheostomy cannula was removed on the 54th day and she was admitted to a sur- gical ward on the 55th postoperative day for further recovery. During dexmedetomidine sedation, her plasma albumin level was low (8.4 g/L to 11.6 g/L) and her creatinine level was slightly elevated (23 μmol/L to 126 μmol/L). Mean- while, her bilirubin level and international normalized ratio (INR) were both normal at 5 μmol/L to 16 μmol/L and 1.1 to 1.4, respectively. At 14 months later, her recovery is still incomplete. Already in the ICU she complained that her vision is impaired. According to the consulting ophthalmologist, this symptom is likely due to ischemic optic neuropathy. At present she can only see movement and light with her right eye. The vision of her left eye is also severely impaired, but she is able to read using special equip- ment for the visually impaired. Additionally, her every- day life is harmed by numbness and weakness of her extremities, which is caused by critical illness polyneuro- pathy. Despite these impairments, her aim is to return to work. Samples for the measurement of dexmedetomidine concentrations in her plasma were drawn at 8-hour intervals as directed by the plan of the pharmacokinetic study she was recruited in. The concentrations were determined using reversed-phase high-performance Figure 1 Dexmedetomidine infusion rate and plasma concentrations. Propofol infusion rate, dexmedetomidine infusion rate and plasma dexmedetomidine concentration during the 24-day high-dose infusion in a critically ill intensive care patient (Dex, dexmedetomidine; Conc, concentration).