Adenosine for Pediatric SVT
Recommended Dosing Protocol
- The American Academy of Pediatrics recommends starting with 0.1 mg/kg (100 mcg/kg) as a rapid IV bolus, followed by 0.2 mg/kg (200 mcg/kg) if needed, up to a maximum of 0.3 mg/kg (300 mcg/kg) 1, 2
- The initial dose is higher than the adult starting dose of 6 mg and reflects the higher doses needed in children compared to adults 2
- Administer via a large proximal vein followed immediately by a rapid 5-10 mL saline flush 3
Clinical Efficacy
- The overall cardioversion success rate is 72-88% for all SVT types, with a success rate of 79-96% for AV node-dependent SVT, according to the American Heart Association 1, 4
- Approximately 90% success rate when adenosine or verapamil are used, superior to digoxin (61-71%), as recommended by the American Academy of Pediatrics 1, 4, 5
Alternative Therapies for Refractory SVT
- Procainamide has higher success rates than amiodarone for refractory pediatric SVT with equal adverse effects, according to the American Heart Association 1, 4, 7
- Synchronized cardioversion is preferred for unstable patients or when pharmacologic therapy fails, as recommended by the American Academy of Pediatrics 1, 4, 5
- Avoid verapamil in infants due to multiple reports of cardiovascular collapse and death, as warned by the American Heart Association 1, 6
Administration Technique
- Use a large, proximal peripheral vein (antecubital preferred) and administer as the most rapid IV push possible, followed by 5-10 mL rapid saline flush, as recommended by the American Academy of Pediatrics 3