Non sempre 6-12-12 è il dosaggio giusto per l’Adenosina

7 Dic

Ci sono alcuni casi particolari in cui il classico dosaggio dell’Adenosina non è quello più appropriato?

Da Academic Life in Emergency Medicine

Ecco due eccezioni che possiamo riscontrare nella nostra pratica clinica

  1. Il paziente che ha recentemente assunto una metilxantina (teofillina o più comunemente caffeina). Le metilxantine sono antagonisti dell’Adenosina e quindi un bolo iniziale di 6 mg rischia di essere inefficace. In questi casi può essere appropriato procedere con 12-18-18 mg. (1)
  2. Quando somministrata in una via venosa centrale (o equivalente per es. attraverso la fistola a-v del dializzato) la dose di Adenosina va ridotta. Il dosaggio raccomandato in questo caso è 3-6-6 mg per evitare spiacevoli effetti collaterali (bradicadia spiccata, blocchi AV avanzati ecc). (2,3,4)
References:
  1. Cabalag MS, et al. Recent caffeine ingestion reduces adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia. Acad Emerg Med 2009;17(1):44-9.
  2. Chang M, et al. Adenosine dose should be less when administered through a central line. J Emerg Med 2002;22(2):195-8.
  3. McIntosh-Yellin NL, et al. Safety and efficacy of central intravenous bolus administration for termination of supraventricular tachycardia. J Am Coll Cardiol 1993;22:741-5.

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