Objective To observe the therapeutic effect and safety of dexmedetomidine for sedation in ICU. Methods We selected 40 patients who transferred to the ICU with retained endotracheal intubation after abdominal surgery under general anesthesia in this study. 40 patients were randomly divided into the dexmedetomidine group (D group,20 cases) and midazolam group (M group,20 cases) . Patients in group D were treated with loading dose 1 μg/kg from central vein pump injection 20 min, 1h according to Ramsay score for each adjustment of drug dose is pumped into 0.2 ~ 0.7 μg/(kg.h). Patients in M group were given a loading dose of midazolam 0.05mg/kg intravenous injection 1 min, depending on the degree of sedation maintenance dose of 0.02 ~ 0.1 mg/(kg.h). Pain scores every 2 h (NRS),when the NRS score>4 sharing,plus fentanyl 1μg/kg. When the patients achieved the offline condition, the endotracheal tube was pulled out. The sedation efficiency, dosage of fentanyl, after discontinuation wake-up time, extubation time, duration of mechanical ventilation, the incidence of cardiovascular events and delirium were compared between two groups.Results The sedation efficacy in Group D sedation was significantly higher than in group M ( <0.05) . Compared with group M, the dosage of fentanyl in patients in D group was significantly reduced ( <0.05), the wake time after stopping, extubation time were significantly shorter ( <0.05) . The incidence of cardiovascular events has no significant difference between two groups during the treatment. The incidence of postoperative delirium in D group was significantly lower than in that in group M ( <0.05) . Conclusions Dexmedetomidine has good sedative effect, and can shorten the time of extubation with hemodynamic stability and low incidence of delirium for patients in the ICU. It is an ideal ICU sedative.

Drug-induced immune thrombocytopenia (DITP) is a very rare disease, with an estimated annual incidence of 10 cases per million. Oxaliplatin and irinotecan are widely used as chemotherapy for high-risk stage II and III colorectal cancer, and DITP has been reported to occur in patients using those agents. To treat unresectable metastatic colorectal cancer, bevacizumab is used in combination with oxaliplatin or irinotecan, and there have been a few reports of DITP cases in patients receiving that regimen. In this report, we describe a 68-year-old male patient with metastatic colon cancer (KRAS mutant type) to the liver and lung who developed acute immune-mediated thrombocytopenia due to bevacizumab-FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) therapy. During treatment, he showed purpura in his lower extremities on 21st cycle day 2. Lab work revealed a platelet count of less than 2,000/mL, reflecting a decrease from 135,000/mL at the start of the cycle 1 day prior. He did not have any other types of cytopenia or significant changes in laboratory findings. We diagnosed DITP due to bevacizumab-FOLFOX, and the patient did not show isolated thrombocytopenia after switching to Ziv-aflibercept-FOLFIRI (5-fluorouracil, leucovorin, and irinotecan).

The FOLFOX regimen (combination of leucovorin, 5-fluorouracil, and oxaliplatin) is the first-line treatment for high-risk stage 2 and 3 colorectal cancer patients. While hypersensitivity reactions (HSRs) caused by oxaliplatin are commonly reported, HSRs due to leucovorin have been infrequently reported. This report aims to investigate the clinical presentation, diagnosis, and management of leucovorin induced HSRs. A 60-year-old female developed generalized edema, dyspnea, and facial redness during cetuximab plus FOLFOX chemotherapy administered for management of metastatic colorectal cancer. Because HSRs induced by oxaliplatin are commonly reported, we initially presumed an oxaliplatin-induced HSR. However, despite undergoing oxaliplatin desensitization, HSRs persisted, and they were still observed when leucovorin was administered without oxaliplatin. The patient was diagnosed with leucovorin-induced HSR and underwent leucovorin desensitization. However, the reactions recurred within 30 minutes of the initiating the desensitization. Considering unsuccessful leucovorin desensitization, leucovorin was excluded. The patient received cetuximab and oxaliplatin chemotherapy without leucovorin to date without any adverse effects. While leucovorin-induced HSRs are infrequently reported, they should still be regarded as potential adverse effects.