Adenosine: An Effective and Safe Antiarrhythmic Drug in Pediatrics

Paul, Thomas; Pfammatter, Jean‐Pierre

doi:10.1007/s002469900129

Cited by 56 publications

(21 citation statements)

References 74 publications

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“…[1][2][3] In our patient, we observed a transient local response with mottling of the skin. Blurred vision, nausea, and dizziness lasted for about 10 minutes.…”

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confidence: 50%

Accidental intra-arterial injection of adenosine in a patient with supraventricular tachycardia

Schure

Vries

2011

Cardiol Young

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Supraventricular tachycardia is the most common symptomatic arrhythmia in children. Acute management in haemodynamically stable patients is pharmacological. The drug of choice is adenosine, a metabolite of adenosine triphosphate, which causes conversion to sinus rhythm by transient atrioventricular block. 1 We describe the case of a 12-year-old girl with supraventricular tachycardia due to Wolff-ParkinsonWhite syndrome. The tachycardia started during physical exercise and both Valsalva manoeuvre and administration of propranolol were tried unsuccessfully. Upon arrival at the hospital, the patient was pale but haemodynamically stable, and the rate of tachycardia was 190 beats per minute. By accident, the intravenous cannula was placed into the left brachial artery and the first dosage of adenosine 150 micrograms per kilogram was administered intraarterially, followed by a flush of 20-millilitre isotonic saline. This resulted in transient pain and mottling of the skin of the forearm. The girl reported blurred vision, dizziness, and nausea. Pulsatile movement of blood was seen in the intravenous tubing and the cannula was removed. Within 10 minutes, the side effects disappeared and a new intravenous cannula was placed. A second dose of adenosine 200 micrograms per kilogram was given as an intravenous bolus, with conversion to sinus rhythm as a result. Inspection of the left arm revealed no abnormalities.To the best of our knowledge, this is the first report on the accidental intra-arterial administration of adenosine. Adenosine is an endogenous nucleoside, formed by dephosphorylation of adenosine triphosphate. 2 Adenosine causes vasodilatation by relaxation of the vascular smooth muscle. Patients can experience this as flushing, lightheadedness, and/or dizziness.Owing to the short half-life time of adenosine -less than 10 seconds -these side effects are short-lived. [1][2][3] In our patient, we observed a transient local response with mottling of the skin. Blurred vision, nausea, and dizziness lasted for about 10 minutes. These adverse events presumably are caused by the intra-arterial injection of adenosine.Iatrogenic intra-arterial injection of drugs is associated with limb ischaemia, skin necrosis, paresthesias, and temperature hypersensitivity. 4 Intra-arterial placement should be suspected when a bright red backflow of blood into the intravenous catheter is seen, in the presence of pulsatile movement of blood, in distal signs of ischaemia, and when a pulse is palpable proximal to the injection site. 5 Prevention and early recognition are of vital importance in reduction of adverse events. 4 Janna M. A. ter Schure, Tjalling W.

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“…[1][2][3] In our patient, we observed a transient local response with mottling of the skin. Blurred vision, nausea, and dizziness lasted for about 10 minutes.…”

mentioning

confidence: 50%

Accidental intra-arterial injection of adenosine in a patient with supraventricular tachycardia

Schure

Vries

2011

Cardiol Young

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“…Dosage is increased in 0.05 to 0.10 mg/kg increments, up to a maximum dose of 0.25 to 0.30 mg/kg or until the tachycardia is terminated. 46,48,49 An effect is usually evident on the ECG within 20 seconds after intravenous administration. A duration of action of less than 1 minute may be expected as intracellular transport and enzymatic deamination to endothelial cells and erythrocytes rapidly take place.5° Of interest to the anesthesiologist is that although early recurrence of the tachycardia is observed in up to one third of patients, adenosine can be repeated without cumulative effect.46,47 Even more advantageous is the absence of significant hemodynamic effects.…”

Section: Adenosine In Infants and Childrenmentioning

confidence: 99%

Diagnosis and Management of Arrhythmias in Children After Cardiac Surgery

Botero

Davies

2001

Semin Cardiothorac Vasc Anesth

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Arrhythmias that lead to hemodynamic deterioration and sudden death are one of the most challenging problems in children after cardiac surgery. In infants with congenital heart disease, disorders of impulse conduction are more frequent than those of impulse generation. Various factors that include anatomic or physiologic abnormalities of the conduction system, damage as a result of hemodynamic stress or chronic hypoxia, and injury occurring at the time of surgery interact to produce dysrhythmias. During the postoperative period, supraventricular tachycardia rarely causes sudden death in children. However, junctional ectopic tachycardia and Wolff-Parkinson-White syndrome are 2 that have been associated with a high mortality rate. In general, ventricular tachycardia carries a more serious prognosis than supraventricular tachycardia because it typically occurs in abnormal myocardium with suboptimal function, which may also be vulnerable to degeneration into ventricular fibrillation. A practical approach to the most common intraoperative and postoperative arrhythmias in pediatric cardiac patients is discussed. Patients at risk, the types of arrhythmias likely to occur after specific cardiac operations, and the most effective current therapies are reviewed.

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“…Bolusgabe von Adenosin (0,1-0,3 mg/kg-KG, KG: Körpergewicht). Sie verursacht durch AV-Blockade und Suppression der Sinusknotenautomatie eine kurzfristige Asystolie [7]. Die Art der Tachykardieter …”

Section: Behandlungunclassified