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Perioperative bradycardia (Drugs (First line = Atropine (500mcg every 3…
Perioperative bradycardia
Management
Stop vagal stimulation
Decide whether to use drugs or pacing
Drugs
First line = Atropine
500mcg every 3 mins to total 3mg
Do not give Atropine to patients with Cardiac transplant (heart is denervated and will not respond to vagal blockade)
Second line - Adrenaline (bolus or infusion 2-10mcg/min to achieve stable HR with MAP = 70)
Third line = Isoprenaline, dopamine, theophylline, glycopyrolate
Consider glucagon or insulin/glucose/potassium therapy if B blocker or CCB overdose
Pacing
Indications
Failure of pharmacotherapy
High risk of asystole (see flowchart)
External
Transcutaneous pacing
Stimulates skeletal and cardiac muscle
Uncomfortable: need analgesia and sedation
Technique
Set to demand = VVI (as req) or fixed/asynchronous =VOO (if risk of artefact)
Default rate = 80
Start low (e.g. 30mA) and gradually increase the output until electrical (QRS and T wave after each spike) and mechanical (pulse) capture (usually 50-100mA)
Pace at 10% above capture threshold
Percussion (fist pacing)
Repeated firm blows to left lower sternal edge with closed fist
Not recommended by ARC but may be considered if electrical pacing (TC or TV) is unreliable
Internal - TV pacing (get expert help!!)