Adenosine: novel antiarrhythmic therapy for supraventricular tachycardia

Adenosine (Adenocard) is a unique new agent for the acute treatment of paroxysmal supraventricular tachycardia (PSVT). Administered by intravenous bolus, it has an onset and duration measured in seconds and greater than 90% efficacy. Its primary effect is to slow atrioventricular nodal conduction, thus converting reentrant forms of PSVT to normal sinus rhythm. Side effects quickly dissipate without treatment because of the short duration of action. Other uses include diagnosis of broad or wide QRS complex tachycardias and controlled intraoperative hypotension. Its short duration and high efficacy in converting select forms of PSVT make adenosine an excellent alternative to verapamil in patients with compromised hemodynamics. This article will review the clinical use and anesthetic implications for the administration of this drug.