Bell Carolyn Magee, Procter Levi D, Parli Sara E
Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
Department of General Surgery, Virginia Commonwealth University, Richmond, VA, USA.
J Pharm Pract. 2022 Aug;35(4):650-653. doi: 10.1177/08971900211001278. Epub 2021 Mar 19.
Acute colonic pseudo-obstruction (ACPO) is a condition characterized by acute dilation of the large bowel without evidence of mechanical obstruction that occurs in a variety of hospitalized patients with many predisposing factors. Management includes supportive care and limitation of offending medications with mainstays of treatment of neostigmine administration and colonic decompression. We report the case of a critically ill patient with ACPO who experienced bradycardia and a brief episode of asystole when receiving concomitant dexmedetomidine and neostigmine infusions but who later remained hemodynamically stable when receiving propofol and neostigmine infusions. The bradycardia and associated hemodynamic instability experienced while on dexmedetomidine and neostigmine infusions were rapidly corrected with atropine and cessation of offending agents. Because ACPO is encountered frequently and the use of dexmedetomidine as a sedative agent in the ICU is increasing, practitioners should be aware of the additive risk of bradycardia and potential for asystole with the combination of neostigmine and dexmedetomidine. Electronic drug interaction databases should be updated and drug information sources should include a drug-drug interaction between dexmedetomidine and neostigmine to reduce the likelihood of concomitant administration.
急性结肠假性梗阻（ACPO）是一种以大肠急性扩张为特征的病症，无机械性梗阻证据，发生于多种有许多易感因素的住院患者中。治疗包括支持治疗和停用相关药物，主要治疗方法是新斯的明给药和结肠减压。我们报告了一例患有ACPO的重症患者，该患者在同时接受右美托咪定和新斯的明输注时出现心动过缓和短暂的心搏停止，但后来在接受丙泊酚和新斯的明输注时血流动力学保持稳定。在输注右美托咪定和新斯的明时出现的心动过缓和相关血流动力学不稳定，通过阿托品和停用相关药物迅速得到纠正。由于ACPO经常遇到，且在重症监护病房中右美托咪定作为镇静剂的使用正在增加，从业者应意识到新斯的明和右美托咪定联合使用会增加心动过缓风险和心搏停止的可能性。电子药物相互作用数据库应更新，药物信息来源应包括右美托咪定和新斯的明之间的药物相互作用，以减少联合给药的可能性。
