Critical Care >Postcardiothoracic Surgery Care

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 54–8Agents for rate and rhythm control.

Agents Mechanism Dose Considerations

Bolus: 0.25 mg/kg IV over 2 min

•Afib with RVR
Diltiazem Calcium channel blocker •Negative inotropic effect may be detrimental in
Continuous: 5-15 mg/h IV
the postcardiac surgical patient and patient with
low EF
PO: 120-360 mg/d in divided doses

Bolus: 2.5-5 mg IV × 3

Metoprolol β1-selective blocker

Standing: 5 mg IV q4h •Afib with RVR

PO: 12.5-100 mg q12h

Bolus: 150 mg IV over 10 min × 2

•Useful in patients on vasopressors, inotropes, or

Continuous: 1 mg/min × 6 h then 0.5 mg/min ×
Amiodarone Na+, K+, Ca2+ and β-blockade with low EF
18 h
•Avoid in patients with liver, pulmonary, or thyroid
dysfunction
PO: 400 mg q12h × 1 wk, then 600 mg daily × 1
wk, then 400 mg daily × 4-6 wk

Load: 0.25 mg IV then 0.125 × 2 q8h

•Dose cautiously in patients with renal
insufficiency
Digoxin Inhibits Na-K ATPase Maintenance: 0.125-0.25 daily or every other day
•Avoid hypokalemia
•Digoxin-specific antibody fragments available for
PO: 0.5 mg daily × 2 d, then 0.125-0.375 PO
digoxin toxicity
daily or every other day

Load: 1 mg/kg
Lidocaine Na channel blocker

Maintenance: 1 mg/h

500 μg/kg IV over 1 min

Esmolol β1-selective blockade
•Short half-life
60-200 μg/kg/min

Afib, atrial fibrillation; EF, ejection fraction; IV, intravenous; PO, oral; RVR, rapid ventricular response.

Date of download: 01/01/23 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.