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Pt in her early 20s had a history of "fast heart rates", not formally diagnosed by a physician. Becomes mildly symptomatic when it occurs at home... sits down until it goes away.
During c-section with SAB becomes tachycardic with HRs in the 180s. BP stable in the 110s to 120s, but pt states she is becoming dizzy and short of breath.
In my anesthesia drawer I have Esmolol, Metoprolol, and Verapamil. I also have Edrophomium and Neostigmine for those who favor a less traditional (or perhaps more traditional) approach.
Which of the afore mentioned medications would be my best bet for treating the patients tachycardia assuming vagal maneuvers had failed and why?
Good clinical scenario, Brenna's Dad. Thanks....
Just one perspective - there are many ways to skin a cat, as everybody knows. I probably would have done the exact same thing as you. By no means am I an expert (!) but it seems to me that we must be good at "tweaking"...trying something (that seems sane, safe and reasonable, of course...) and then watching what happens...then trying some else if need be. Anyway, thanks for a good discussion.....
i agree - i too would have had to ask what was the best med to use - haven't run into that scenario - thanks for the heads up.
as per acls, you could have used the adenosine on the mother. the half life is quite beneficial in this case! followed by fluids, repostioning and o2.
additionally, beta blockers are ok.
ammioderone is ***NOT*** recommended in pregnant women for tachy arhythmias.
Brenna's Dad
394 Posts
I don't think the question was whether Neo caused fetal comprise, but that it decreased uterine artery blood flow.