Kimura K, Kai S, Egi M. Paroxysmal supraventricular tachycardia associated with dexmedetomidine withdrawal in an adult liver transplant recipient: A case report. World J Crit Care Med 2026; 15(2): 120336 [DOI: 10.5492/wjccm.v15.i2.120336]
Corresponding Author of This Article
Shinichi Kai, MD, PhD, Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. s.kai0627@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
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Kimura K, Kai S, Egi M. Paroxysmal supraventricular tachycardia associated with dexmedetomidine withdrawal in an adult liver transplant recipient: A case report. World J Crit Care Med 2026; 15(2): 120336 [DOI: 10.5492/wjccm.v15.i2.120336]
World J Crit Care Med. Jun 9, 2026; 15(2): 120336 Published online Jun 9, 2026. doi: 10.5492/wjccm.v15.i2.120336
Paroxysmal supraventricular tachycardia associated with dexmedetomidine withdrawal in an adult liver transplant recipient: A case report
Karen Kimura, Shinichi Kai, Moritoki Egi
Karen Kimura, Shinichi Kai, Moritoki Egi, Department of Anesthesia, Kyoto University Hospital, Kyoto 606-8507, Japan
Author contributions: Kimura K drafted the manuscript and collected clinical data; Kai S managed the patient and contributed to data interpretation; Egi M supervised the study and critically revised the manuscript; and all authors approved the final version.
AI contribution statement: We only used AI tools such as ChatGPT and DeepL for language review and proofreading. The main text content was independently written by the authors, and no AI tool was used in study design or result interpretation. All figures and tables were created by ourselves.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Shinichi Kai, MD, PhD, Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan. s.kai0627@gmail.com
Received: February 25, 2026 Revised: March 12, 2026 Accepted: March 25, 2026 Published online: June 9, 2026 Processing time: 85 Days and 22.6 Hours
Abstract
BACKGROUND
Dexmedetomidine is a selective α2-adrenergic receptor agonist widely used for sedation and anxiolysis in intensive care units (ICUs). Abrupt discontinuation after prolonged infusion may induce withdrawal symptoms because of sympathetic rebound. Although sinus tachycardia and hypertension are common manifestations, clinically significant tachyarrhythmias have rarely been reported in adults.
CASE SUMMARY
A woman in her 60 years was readmitted to the ICU for septic shock following liver transplantation. Prolonged high-dose dexmedetomidine infusion was required to manage sleep disturbance and anxiety. Two hours after abrupt discontinuation of dexmedetomidine, the patient developed paroxysmal supraventricular tachycardia that was refractory to adenosine triphosphate and landiolol. Reinitiation of dexmedetomidine promptly restored sinus rhythm, suggesting withdrawal-related sympathetic overactivity as the precipitating mechanism. Gradual tapering prevented recurrence.
CONCLUSION
Dexmedetomidine withdrawal should be considered in adult ICU patients presenting with unexplained tachyarrhythmia. Careful tapering and multimodal sedation strategies are essential when prolonged dexmedetomidine administration is anticipated.
Core Tip: Dexmedetomidine withdrawal in adults is often underrecognized owing to the absence of standardized diagnostic criteria. Although most reports have described hypertension and sinus tachycardia, this case demonstrates paroxysmal supraventricular tachycardia as a potentially severe manifestation. The arrhythmia was refractory to conventional antiarrhythmic therapy, including adenosine triphosphate and β-adrenergic antagonists, but resolved rapidly after dexmedetomidine reinitiation. Clinicians should carefully review medication timelines in unexplained intensive care unit arrhythmias and avoid abrupt discontinuation after prolonged high-dose dexmedetomidine infusion.
