A new dosing regimen for esmolol to treat supraventricular tachyarrhythmia in Chinese patients

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Abstract

Objective. The purpose of this study was to find a safe dosing regimen for esmoiol infusion to rapidly control supraventricular tachyarrhymia after cardiac surgery to Chinese patients. Background. Tachycardia increase cardiac work but reduces myocardial perfusion. Thus, in the critical period immediately after cardiac surgery, tachycardia itself warrants urgent intervention. Esmolol an ultrashort-acting beta-adrenergic blocking agent, has been reported In western published reports to have good remits and few side effects In the treatment of supraventricular tachyarrhythmia. However, its clinical application in Chinese patients has not yet been reported. Methods. When supraventricular tachyarrhymia with a rapid ventricular response (>110/min) was found early after surgery esmolol infusion with a different dosing regimen was used to control the tachyarrhythmia. Results. With the dosing regimen recommended in western published reports (repeated loading infusion with stepwise increment), acute hypotension with systolic pressure <80 mm Hg occurred in all ste patients after 1 min of loading infusion of esmolol (500 μg/kg body weight per min). To avoid the aforementioned complications, a new dosing regimen was constructed. The initial infusion rate of esmolol was set at 150 or 100 μg/kg per min, depending on the patient's age and blood pressure. When the desired heart rate was achieved, the initial infusion rate was reduced to the maintenance infusion rate to maintain the therapeutic effect [Maintenance infusion rate = Initial infusion rate x (1 - e-0.077t), where t is the time period in minutes required by the initial infusion of esmolol to achieve the therapeutic effect]. With this new dosing regimen, tachycardia in most patients (9 of 11) could be controlled within 10 mm, and no one experienced the side effect of hypotension. The maintenance infusion rate of esmolol needed to control supraventricular tachyarrhythmia in our patients was only 73 ± 42 μg/kg per min (mean ± SD), much less than that noted hi western reports. Conclusions. The dosing reghnen for esmolol infusion recommended in western studies is not suitable for Chinese patients. In this report we propose a new dosing regimen for esmolol infusion that is both safe and rapid in the treatment of supraventricular tachyarrhythmia in Chinese patients. © 1994.

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Ko, W. J., & Chu, S. H. (1994). A new dosing regimen for esmolol to treat supraventricular tachyarrhythmia in Chinese patients. Journal of the American College of Cardiology, 23(2), 302–306. https://doi.org/10.1016/0735-1097(94)90411-1

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