Cardiac Medication Infusion; How Safe We Play!

It always seems easy when we follow the protocol in the OT and Recovery room without exactly knowing the strengh of the medication. Nurses make our work easy many often. We just order to start dopamine or adrenaline at 2 or 4 ml/hr and increase or decrease according to response. The same reason make us uncomfortable to work in pediatric cardiac surgery if we work in adult surgery.

Fig: Emergency medications used in Cardiac Recovery Room

Lets be specific; what are the medicines we use in surgery and after surgery and their  dosage range? Residents always have nightmare remembering the exact dosage. I am not an exception!

 

Adrenaline= 0.01-0.05 mcg/kg/min
NorAdrenaline= 0.01-0.5 mcg/kg/min
Vasopressin= 0.01-0.07 units/min
Dopamine= 2-20 mcg/kg/min
Dobutamine= 5-20 mcg/kg/min
Milrinine = 50 mcg bolus then 0.375-0.75 mcg/kg/min

We uses 50ml syringe pumps for infusion. Hence, required dose of drug diluted till 50ml; this is to remember. 

Adr/NorAdr/Isoprenaline/Levosimendan dose=( Weight of the Patient*0.3). Hence 1cc/hr will be 0.1 mcg/kg/min

Dopamine/SNP/NTG/Milrinone/Midazolam/Atracurium dose = Weight of the Patient * 3. Hence 1cc/hr will be 1 mcg/kg/min.

Many paediatric people must have been following this guideline. Adult protocol is same but we go by nurses. To conclude, I can say, It works magic for everybody. You will definitely feel confident when you know.

 

Author: what2talk

Myself, Dr. Sibashankar Kar, doing my Cardiothoracic Surgery in Sir Ganga Ram Hospital. The purpose I have made this website is to discuss on the topics of cardiology and cardiac surgery as a whole with their complexities.

2 thoughts on “Cardiac Medication Infusion; How Safe We Play!”

  1. Very well written. Commencing inotropes vasopressor empirically can sometimes land up our patient in big trouble. E.g. Vasopressin more than 0.04 u /min can dangerously cause peripheral vasospasm and even gangrene. Always know ur Drug, Dosage and the rate of infusion

    As I always say to my friends, lack of knowledge is criminal negligence for doctors as we deal with life directly.

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