Iirola et al. Journal of Medical Case Reports 2010, 4:73 http://www.jmedicalcasereports.com/content/4/1/73 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Highly variable pharmacokinetics of dexmedetomidine during intensive care: a case report Timo Iirola1*, Ruut Laitio1, Erkki Kentala1, Riku Aantaa1, Juha-Pekka Kurvinen2, Mika Scheinin2, Klaus T Olkkola1 Abstract Introduction: Dexmedetomidine is a selective and potent alpha2-adrenoceptor agonist licensed for use in the sedation of patients initially ventilated in intensive care units at a maximum dose rate of 0.7 μg/kg/h administered for up to 24 hours. Higher dose rates and longer infusion periods are sometimes required to achieve sufficient sedation. There are some previous reports on the use of long-term moderate to high-dose infusions of dexmedetomidine in patients in intensive care units, but none of these accounts have cited dexmedetomidine plasma concentrations. Case presentation: We describe the case of a 42-year-old Caucasian woman with severe hemorrhagic pancreatitis following laparoscopic cholecystectomy who received dexmedetomidine for 24 consecutive days at a maximum dose rate of 1.9 μg/kg/h. Samples for the measurement of dexmedetomidine concentrations in her plasma were drawn at intervals of eight hours. On average, the observed plasma concentrations were well in accordance with previous knowledge on the pharmacokinetics of dexmedetomidine. There was, however, marked variability in the concentration of dexmedetomidine in her plasma despite a stable infusion rate. Conclusion: The pharmacokinetics of dexmedetomidine appears to be highly variable during intensive care. Introduction Dexmedetomidine is a selective and potent alpha2-adre- noceptor agonist licensed for the sedation of patients initially ventilated in intensive care units (ICU) at a maxi- mum dose rate of 0.7 μg/kg/h administered for up to 24 hours. Higher dose rates and longer infusion periods are sometimes required to achieve sufficient sedation. We describe the case of a 42-year-old Caucasian woman with severe hemorrhagic pancreatitis following laparoscopic cholecystectomy, who received dexmedetomidine for 24 consecutive days at a maximum dose rate of 1.9 μg/kg/h. Case presentation A 42-year-old Caucasian Finnish woman was scheduled for laparoscopic cholecystectomy due to typical symp- toms and radiological findings of gallstones. She was obese (89 kg, BMI = 33), even though she had managed * Correspondence: tiirola@utu.fi 1Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Turku and Turku University Hospital, FIN-20521, Turku, Finland to lose weight by 20 kg six months prior to presenta- tion. She was using sibutramine and oral contraceptives as regular medication. Surgery was uneventful, but on the second postopera- tive day, the general state of our patient started to dete- riorate, resulting in anuria and difficulty of breathing, admission into the intensive care unit (ICU), endotra- cheal intubation, and mechanical ventilation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed upon ICU admission because of suspected biliary tract leakage. However, no signs of leakage were observed. Computed tomography (CT) examination revealed fluid around her liver, while her pancreas could not be visualized. Her plasma amylase concentration was elevated, thus confirming the diagnosis of pancreatitis. Due to decreased renal function, she was commenced on continuous hemodiafiltration therapy on the third day and continued until the 10th postoperative day. Pro- pofol infusion for sedation, supplemented with intrave- nous oxycodone boluses, was started as part of our hospital’s standard therapy in order to facilitate © 2010 Iirola et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.