Vol 7 | Issue 1 | January-April 2021 | Page 11-13 | Aidan Spring, Evelyn Lynn
Author: Robert J. Long , Henry R. DeYoung , Gregory J. Booth , Marcus G. Herod 
 Naval Medical Center Portsmouth, Anesthesia and Pain Management, 620 John Paul Jones Circle, Portsmouth, VA 23708.
Address of Correspondence
Dr. Robert J. Long,
Naval Medical Center Portsmouth, Anesthesia and Pain Management, 620 John Paul Jones Circle, Portsmouth, VA 23708.
Opioid-Free Naloxone Emergence Under Dexmedetomidine: A Case Report
This report describes a case in which naloxone appeared to expedite emergence from general anesthesia in a patient who underwent an opioid-free anesthetic that included dexmedetomidine. After administration of naloxone, the patient progressed rapidly from general anesthesia to alert and oriented in approximately two minutes. Additionally, the patient demonstrated rapid reversal of miosis. He also reported adequate analgesia in the PACU, requiring no opioids and denied any recall of events that occurred prior to the administration of naloxone.
Keywords: Naloxone, Dexmedetomidine, Delayed emergence.
1. Naaz S, Ozair E. Dexmedetomidine in current anesthesia practice- a review. Journal of clinical and diagnostic research: JCDR. 2014;8(10):Ge01-4.
2. Chabot-Doré AJ, Schuster DJ, Stone LS, Wilcox GL. Analgesic synergy between opioid and α2-adrenoceptors. British journal of pharmacology. 2015;172(2):388-402.
3. Sullivan AF, Kalso EA, McQuay HJ, Dickenson AH. The antinociceptive actions of dexmedetomidine on dorsal horn neuronal responses in the anaesthetized rat. Eur J Pharmacol. 1992;215(1):127-33.
4. Boyer EW. Management of opioid analgesic overdose. The New England journal of medicine. 2012;367(2):146-55.
5. Helm S, Trescot AM, Colson J, Sehgal N, Silverman S. Opioid antagonists, partial agonists, and agonists/antagonists: the role of office-based detoxification. Pain physician. 2008;11(2):225-35.
6. Keinbaum, P., et al. Sympathetic Neural Activation Evoked by μ-Receptor Blockade in Patients Addicted to Opioids Is Abolished by Intravenous Clonidine. Anesthesiology. 2002: 96:346-351.
7. Farsang C, Kunos G. Naloxone reverses the antihypertensive effect of clonidine. British journal of pharmacology. 1979;67(2):161-4.
8. Kulig K, Duffy J, Rumack BH, Mauro R, Gaylord M. Naloxone for treatment of clonidine overdose. Jama. 1982;247(12):1697.
9. Cook P. Clonidine-induced unconsciousness: reversal with naloxone. Anaesthesia and intensive care. 1987;15(4):470-1.
10. Ahmad SA, Scolnik D, Snehal V, Glatstein M. Use of naloxone for clonidine intoxication in the pediatric age group: case report and review of the literature. Am J Ther. 2015 Jan-Feb. 22 (1):e14-6.
11. Tsze DS, Dayan PS. Treatment of guanfacine toxicity with naloxone. Pediatric emergency care. 2012;28(10):1060-1.
12. Seger, D. and Loden, J. Naloxone reversal of clonidine toxicity: Dose, Dose, Dose. Clinical Toxicology. 2018:56(10):873-879.
13. Niemann JT, Getzug T, Murphy W. Reversal of clonidine toxicity by naloxone. Annals of emergency medicine. 1986;15(10):1229-31.
14. 12. Uskur T, Barlas MA, Akkan AG, Shahzadi A, Uzbay T. Dexmedetomidine induces conditioned place preference in rats: Involvement of opioid receptors. Behav Brain Res. 2016;296:163-8.
15. Sleigh, J., et al. Ketamine – More mechanisms of action than just NMDA blockade. Trends in Anaesthesia and Critical Care. 2014:4(2-3):76-81.
16. Cascella M, Bimonte S, Di Napoli R. Delayed Emergence from Anesthesia: What We Know
and How We Act. Local Reg Anesth. 2020 Nov 5;13:195-206. doi: 10.2147/LRA.S230728.
|How to Cite this Article: Long RJ, DeYoung HR, Booth GJ, Herod MG | Opioid-Free Naloxone Emergence Under Dexmedetomidine: A Case Report | Journal of Anaesthesia and Critical Care
Case Reports | January-April 2021; 7(1): 11-13.