Seen a few of these before intraoperative. I thought first line is adenosine unless unstable then sync shock. However I've never seen adenosine used in the OR for Svt. They usually use other drugs first like esmolol or dilt which I thought were 2nd line. What are your thoughts? Do you go for the adenosine first if svt doesn't break on its own after a few minutes?
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Intraoperative svt
Started by anbuitachi
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deleted162650
First I mash on their eyeballs and dump ice on their head. When that doesn’t work I go straight to vigorous bilateral carotid massage.
In the OR I would probably only be reaching for adenosine first if the patient had a history of SVT or some primary structural heart disease. Most of the SVT I see occurs in sicker patients who are having some sort of oxygen demand/supply imbalance. In someone who is semi-stable (sbp 80-90), rather than risk having a nodal pause that degenerates into something worse I'd rather push esmolol/neo first and make sure I've corrected hypoxia, anemia, relative hypotension, electrolytes and volume status before reaching for the big guns. Obviously though, make sure the adenosine and pads are still handy before trying to fix secondary causes.
Bilateral carotid massage?? Hahahhaaa ok
I’ve had Adenosine not work tried Esmolo next and no bueno. Did carotid message and BAM. All good.
Ever tried neostigmine?
why....
I've broken it occasionally with a good Valsalva via the vent.
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deleted171991
Vagal maneuver, I guess. 😕
That's smart. Did this work for you?
Old school!
ive never actually done the ice one before. tried valsalva / carotid massage. how many Kg of ice do you dump on the patients face?
They were all toddlers, so just a ziploc bag filled with ice/water mixture and quickly applied to the face.
