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Pharmacologic treatment of intraoperative supraventricular tachycardias

Pharmacologic treatment of intraoperative supraventricular tachycardias
Medication Recommended dosage (IV)
Adenosine 6 mg rapid bolus; if not effective within 1 to 2 minutes, give 12 mg; if not effective within 1 to 2 minutes, may repeat 12 mg.
Metoprolol 1.0 to 5 mg bolus over 2 minutes; may repeat 2 times.
Esmolol 1 mg/kg initial bolus, followed by 150 mcg/kg per minute infusion.
Verapamil 0.07 to 0.15 mg/kg (usually 5 to 10 mg/dose [maximum 10 mg]) IV over 2 to 3 minutes; may repeat once every 15 to 30 minutes if necessary. If no response, start 0.005 mg/kg per minute infusion.
Diltiazem 0.25 mg/kg bolus over 2 minutes; start 5 to 15 mg/hour infusion.
Amiodarone 150 mg IV bolus over 10 minutes, then start infusion at 1 mg/min for 6 hours, followed by 0.5 mg/min for 18 hours.
These agents are appropriate for patients with most supraventricular tachycardias. However, all of these drugs are contraindicated in patients with pre-excited atrial fibrillation.
IV: intravenous; SVTs: supraventricular tachyarrhythmias.
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