Antiarrhythmics, Inotropes, and Vasopressors

Antiarrhythmics, Inotropes, and Vasopressors

Bethany R. Tellor (Barnes-Jewish Hospital, USA) and Keki R. Balsara (Washington University School of Medicine, USA)
Copyright: © 2015 |Pages: 16
DOI: 10.4018/978-1-4666-8603-8.ch010
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Abstract

Arrhythmias, low cardiac output syndromes, and low blood pressure are commonly faced complications in the cardiothoracic surgery patient. In order to provide appropriate clinical management, one must identify underlying etiologies while recognizing and understanding available treatment options. The objective of this chapter is to review common agents utilized to manage arrhythmias and maintain hemodynamic stability following cardiac surgery. Mechanisms of action, key clinical pearls and relevant literature pertaining to each agent will be discussed.
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Antiarrhythmic Agents

Antiarrhythmic drugs exert their action by blocking sodium, potassium or calcium. They are classified as either Class IA (prolong action potential), IB (shorten action potential), IC (slow conduction), II (block beta adrenergic receptors), III (prolong repolarization), and IV (blocker calcium channels) (Table 1.) While a number of medications exist in each category, most intensive care units use a handful of medications with which they have familiarity. Guidelines related to the pharmacological management of perioperative atrial fibrillation for cardiothoracic surgery patients highlight the use of β –blockers and amiodarone (Martinez, 2005a; Martinez 2005b; Frendl, 2014).

Table 1.
Vaughn-Williams Classification of Antiarrhythmic Agents
     ClassificationAgentsPrimary Ion Blockade/Effect
1aDisopyramide
Quinidine
Procainamide
Na+
Increased refractory period
1bLidocaine
Mexiletine
Na+
Decreased refractory period
1cFlecainide
Propafenone
Na+
No effect on refractory period
IIMetoprolol
Atenolol
Esmolol
Ca 2+ (through β-receptor blockade)
Increased refractory period
Decreased atrioventricular conduction
IIIAmiodarone
Dronedarone
Sotalol
Dofetilide
K+
Increased refractory period
IVVerapamil
Diltiazem
Ca2+
Increased refractory period
Decreased atrioventricular conduction

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