Acute hemodynamic effects of intravenous amiodarone treatment in paediatric cardiac surgical patients

Abstract

A slow bolus administration of 5 mg/kg amiodarone over at least 60 min followed by one or two additional boluses or a continuous infusion with 10-20 mg/kg day(-1) is a safe treatment strategy without the need for additional inotropic support and with dramatic improvement of heart rate, blood pressure and filling pressures. This protocol can be recommended for paediatric patients in the early postoperative setting.

Pharmacokinetics of intravenous amiodarone in children

“…However, only 5% of patients had heart rates less than the 2nd age-adjusted centile, which was within the 5% to 9.1% range for ‘significant bradycardia’ reported by Saul et al and the 0% to 10% range from retrospective studies 5–9. The safety of IV amiodarone regarding BP and heart rate in children with postsurgical arrhythmias has additionally been demonstrated by Haas et al 18…”

Part 14: Pediatric Advanced Life Support

“…• Consider amiodarone 5 mg/kg IO/IV 308,309 or procainamide 15 mg/kg IO/IV 236 for a patient with SVT unresponsive to vagal maneuvers and adenosine and/or electric cardioversion; for hemodynamically stable patients, expert consultation is strongly recommended prior to administration (Class IIb, LOE C). Both amiodarone and procainamide must be infused slowly (amiodarone over 20 to 60 minutes and procainamide over 30 to 60 minutes), depending on the urgency, while the ECG and blood pressure are monitored.…”

Part 10: Pediatric Basic and Advanced Life Support

“…One LOE 4 randomized, prospective study 316 and 15 LOE 4 small case series and observational studies in infants and children 298,299,314,315,347–357 showed that amiodarone was effective in the treatment of supraventricular tachyarrhythmias. Generalization to pediatric SVT treatment with amiodarone may be limited, however, since most of these studies in children involved postoperative junctional tachycardia.…”