Children with Paroxysmal Supraventricular Tachycardia: Are the Guidelines Giving You a Good Enough Dose?

James Clark*
Cardiff University, UK Email:*
Adenosine is a cardio-active drug used in terminating supraventricular tachycardia. Adenosine has a short half-life and can be administered in boluses of every increasing size until the tachycardia is terminated. Paediatric Guidelines vary on what starting dose should be administered in children to be effective. Best evidence topic reports are summaries of the best available evidence for an emergency medicine topic. Best evidence topic reports are introduced with a clinical scenario, a three-part question, followed by a search strategy, results presentation and a discussion. This poster presents the findings for of a best evidence topic report which determined how effective guidelines are in recommending an initial dose of adenosine in paroxysmal supraventricular tachycardia (PSVT).

A search of Medline and the Cochrane Central Register of controlled trials was conducted. Included articles reported data from individual patients related to their individual doses used to terminate the PSVT. All male and female children 0-18 years of age with PSVT terminated by an adenosine bolus were eligible for conclusion.

Doses administered for PSVT termination were reported in relationship to their effectiveness across the 322 patients. Doses administered ranged between 40?g/kg and 500?g/kg. Current guidelines suggest a starting dose which is effective in 9% of cases [Royal College of Paediatrics and Child Health (RCPCH), Advanced Paediatric Life Support (APLS)] to 41% [Pediatric Advanced Life Support (PALS)]. Adenosine is safe to administer through a peripheral vein. Adverse events occurred in 15 patients and included chest pain, vomiting, facial flushing, and bradycardia. Isolated ventricular ectopic beats occurred in two patients.

A starting dose of 200µg/kg would be effective in 242/322 (75%) of patients included in this data set. Use of adenosine is associated with few side effects.
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