An Exaggerated Hypertensive Response to Glycopyrrolate Therapy for Bradycardia Associated with High-Dose Dexmedetomidine

At our institution, high-dose IV dexmedetomidine is used to provide sedation for pediatric patients undergoing nonpainful radiological imaging studies. Some of these patients exhibit marked bradycardia (more than 20% deviation from the lowest age-adjusted normal values) while maintaining an arterial blood pressure within an acceptable normal range. We report on three cases wherein treatment of dexmedetomidine-induced bradycardia with IV glycopyrrolate (5.0 mu g/kg) not only resulting in resolution of bradycardia but also resulting in an exaggerated increase of arterial blood pressure.