Adenosine for acute management of paroxysmal supraventricular tachycardia
Adenosine can be considered for the acute management of paroxysmal supraventricular tachycardia if vagal manoeuvres do not restore sinus rhythmBrugada 2020.
Before giving adenosine, the patient should have a 12-lead electrocardiogram (ECG) to confirm the diagnosis of supraventricular tachycardiaBrugada 2020.
A suitable regimen of adenosine to restore sinus rhythm in patients with paroxysmal supraventricular tachycardia is:
adenosine 6 mg by rapid intravenous injection; if ineffective after 2 minutes, give 12 mg by rapid intravenous injection; if this is still ineffective but well tolerated, give 18 mg by rapid intravenous injectionBrugada 2020Page 2016. adenosine adenosine adenosine
Adenosine is best given over 1 to 2 seconds (ie rapid intravenous injection), followed by a rapid flush with sodium chloride 0.9%; this is most effective via an upper-limb proximal peripheral intravenous cannula (eg in the cubital fossa, rather than distal near the hand)Brugada 2020.
When giving adenosine, serious acceleration of ventricular response following the initial atrioventricular blockade has been reported; ensure ready access to resuscitation equipment, and use continuous ECG and oxygen-saturation monitoring, and intermittent blood-pressure monitoringBrugada 2020Rankin 1993.
Counsel the patient that they may experience a sensation of doom after receiving adenosine, but the feeling will be temporary. Adenosine is contraindicated in patients with asthma as it can precipitate or aggravate acute bronchospasm. Avoid adenosine in patients with chronic obstructive pulmonary disease who have significant wheezing.