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Adenosine Administration With a Stopcock Technique Delivers Lower-Than-Intended Drug Doses

Nathaniel T Weberding1, Richard A Saladino1, M Beth Minnigh2

  • 1Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

Annals of Emergency Medicine
|November 2, 2017
PubMed

Insights

Adenosine administration via stopcock may deliver lower doses in infants under 10 kg, potentially explaining their reduced response to acute supraventricular tachycardia treatment.

Area of Science:

  • Pediatric Cardiology
  • Pharmacology
  • Medical Device Engineering

Background:

  • Adenosine is the standard treatment for pediatric acute supraventricular tachycardia.
  • Infants often show a diminished response to the initial adenosine dose.
  • The stopcock method for adenosine administration is widely used in pediatric care.

Purpose of the Study:

  • To investigate if the stopcock method delivers sub-therapeutic adenosine doses in pediatric patients weighing less than 10 kg.
  • To correlate adenosine delivery efficacy with patient weight.

Main Methods:

  • An in vitro model simulating adenosine delivery through a stopcock was developed.
  • Adenosine doses were calculated for weights ranging from 2 to 25 kg (0.1 mg/kg).
  • Adenosine concentration in the output was quantified using mass spectrometry and spectrophotometry.

Main Results:

  • Delivered adenosine doses increased proportionally with patient weight.
  • Mean delivered dose was 0.08 mg/kg for weights 2-9 kg and 0.1 mg/kg for 10-25 kg.
  • Median delivered doses were significantly lower for infants under 10 kg compared to older children.

Conclusions:

  • The stopcock method results in underdosing of adenosine in pediatric patients weighing less than 10 kg.
  • This sub-therapeutic dosing may explain the observed decreased efficacy of adenosine in infants.
  • Clinical practice may need adjustment for adenosine administration in low-weight infants.
Abstract

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