Dexmedetomidine-Induced Fever

Abstract

Objective: To report a case of a patient who developed high fever shortly after dexmedetomidine was started and resolved rapidly after discontinuation. This appears to be a rare adverse event that should be brought to the attention of critical care practitioners. Case Summary: A 68-year-old male with no previous medical history was admitted after experiencing a non-ST elevation myocardial infarction. On hospital day 10, he underwent coronary artery bypass grafting and mitral valve replacement. Initially, he did well and was extubated the following day. On postoperative day (POD) 2, he went into respiratory failure and was intubated and started on lorazepam and fentanyl infusions for sedation. His maximum temperature at this point was 38.7°C. He was treated appropriately for a possible systemic inflammatory response syndrome/septic shock. On POD 4, he was initiated on a lidocaine drip following 2 episodes of ventricular fibrillation. On POD 5, the patient was initiated on dexmedetomidine for sedation, and his temperature was 36.8°C. A maximum temperature of 40.6°C was reached 17 hours after the initiation of the drip. Lidocaine was discontinued, and the temperature decreased from 39.7°C to 39.2°C over 2 hours. At this time, dexmedetomidine was discontinued, and within 2 hours his temperature decreased from 39.2°C to 38.4°C. Discussion: There has only been one other published case reported in the literature regarding fever with dexmedetomidine. Since lidocaine cannot be completely ruled out, the Naranjo probability scale indicated that dexmedetomidine was the possible cause of the fever; however, the patient remained afebrile while on lidocaine until dexmedetomidine was initiated. Conclusions: This case demonstrates a possible cause of dexmedetomidine-induced fever. It is important for physicians to recognize this as a possible side effect and consider dexmedetomidine in the differential diagnosis of patients who develop fever in the intensive care unit.