Use of Aminophylline in the Treatment of Severe Symptomatic Bradycardia Resistant to Atropine

Pasnoori, Venkat; Leesar, Massoud A.

doi:10.1097/01.crd.0000096418.72821.fa

Cited by 32 publications

(28 citation statements)

References 25 publications

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“…The reported number of SCI patients requiring a pacemaker varies from 9 to 17%. 2,12 similar to our 10%. Cardiac pacemakers are however not without their problems.…”

Section: Discussionsupporting

confidence: 90%

“…This may reflect a greater extent of SCI-associated cardiovascular disruption among these patients. Pharmacological measures, such as atropine, inotropes and aminophylline, 11,12 are drugs of choice in the management of symptomatic bradycardia. Pharmacological measures are however not always successful.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Treatment of life-threatening bradycardia in SCI generally includes oxygen, atropine, inotropes and aminophylline. 11,12 In refractory cases, and for those associated with a life-threatening events, such as an asystolic cardiac arrest, temporary and permanent pacemakers have been used. 3,7,11 However criteria for the optimal timing and prophylactic use of pacemakers in SCI are poorly defined.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac pacing in patients with a cervical spinal cord injury

et al. 2010

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Study design: Retrospective medical record review. Objectives: To compare patients, admitted to an intensive care unit (ICU) with an acute cervical spinal cord injury (SCI) and documented motor deficit, who did, with those who did not, require a cardiac pacemaker. Setting: South Australian Tertiary Referral Intensive Care and Spinal Injury Unit. Methods: Retrospective medical record review and data set linkage. Results: From 1995 to 2007, 465 patients sustained a cervical SCI. Of these, 30 (6.5%) were admitted to ICU with a clinically assessable motor deficit and 3 (0.6% of all patients, or 10% of those admitted to ICU) required a cardiac pacemaker. All three patients had a cervical SCI, C5 (American Spinal Injury Association A) tetraplegia, and required invasive mechanical respiratory and inotropic support and a tracheostomy for weaning. Two patients (66%) were discharged alive to rehabilitation. Patients requiring a pacemaker had bradycardic episodes over a longer period (11 vs 4 days, P ¼ 0.01), a trend towards a later onset of bradycardia (8 vs 1.5 days, P ¼ 0.05) and a longer ICU length of stay (37 vs 10 days, P ¼ 0.02). Conclusion: Patients with a cervical SCI requiring a cardiac pacemaker are characterized by a higher level of SCI injury and motor loss, require mechanical respiratory and inotropic support, a tracheostomy to wean, and bradycardic episodes of a later onset and over a longer period of time. These findings suggest that such patients should be managed at hospitals with specialized acute spinal injury, intensive care and cardiac pacemaker services.

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“…The reported number of SCI patients requiring a pacemaker varies from 9 to 17%. 2,12 similar to our 10%. Cardiac pacemakers are however not without their problems.…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac pacing in patients with a cervical spinal cord injury

et al. 2010

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“…In 70% -80% of patients with acute coronary syndrome, atropine (1 -3 mg) can be useful for the treatment of symptomatic bradycardia; in fact, intravenous administration of atropine can lead to increased heart rate. However, some elderly patients with bradycardia are resistant to atropine, and therefore, other drugs such as aminophylline (1), isoproterenol (2), and ephedrine (3) are used for the management of symptomatic bradycardia.…”

Section: Introductionmentioning

confidence: 99%

Ephedrine Is More Effective Than Atropine for the Treatment of Symptomatic Bradycardia in Elderly Patients

Shahriari

Khooshideh

2017

Shiraz E-Med J

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Background: Bradycardia may result in the exacerbation of myocardial dysfunction in elderly patients. Objectives: In this retrospective cohort study, ephedrine and atropine were compared for the treatment of symptomatic bradycardia. Methods: In this study, patients (above 65 years) with symptomatic bradycardia during skin tumor resection were evaluated. Symptomatic bradycardia was defined as heart rate below 49 beats per minute and systolic blood pressure below 85 mmHg. According to the anesthesiologist's decision, 1 group of patients (atropine group) received atropine (0.5 mg) as the first-line drug, while the other group (ephedrine group) received ephedrine (10 mg) as the first-line drug to restore hemodynamic parameters. If the initial treatment had no effects on the management of the symptoms, ephedrine (10 mg) was administered to the patients in both groups. The number of patients, who received treatment with a single drug to normalize their hemodynamic parameters, was compared with those who required a second drug. Results: Among 194 subjects with symptomatic bradycardia, 86 and 108 patients were allocated to the atropine and ephedrine groups, respectively. Based on the findings, 35 patients in the atropine group required the second drug for bradycardia management; therefore, 51 patients were treated with only atropine (efficacy: 51/86, 59.30%). Moreover, 21 patients in the ephedrine group required the second dose of ephedrine for the management of bradycardia; consequently, 87 patients were treated with only ephedrine (efficacy: 87/108, 80.55%). There was a statistically significant difference between the 2 groups (P = 0.001). Conclusions: Ephedrine is more effective than atropine in the management of symptomatic bradycardia in elderly patients.

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“…Bradycardia affects as many as 35-71 % of patients with incomplete motor spinal cord injury [1]. These cardiovascular disturbances usually develop within 3-5 days following injury, and typically resolve in 6-8 weeks [5][6][7].…”

Section: Introductionmentioning

confidence: 99%