Treatment of symptomatic bradycardia is largely algorithm-based, regardless of cause. Acting quickly to treat the bradycardia takes precedence over determining the cause. Once you have initiated treatment, proceed to determine the cause and correct, if possible (See section on “Management of Bradycardia in the OR”).
Decide whether the patient has adequate or poor perfusion, since the treatment sequence is determined by the severity of the patient's clinical presentation. In the OR or anesthetized patient:
* If severe hypotension, persistent poor perfusion, or low ETCO2 (<15mm Hg)–> start CPR
* Administer 100% Oxygen, assist ventilation, open IV fluids, and secure airway
* Consider 0.5mg atropine IV while awaiting pacer. May repeat to total 3mg. If ineffective, begin transcutaneous pacing.
* Consider IV bolus Epinephrine 10-100mcg. May start low dose epinephrine infusion if a response (0.05-0.10 mcg/kg/min) or dopamine (2-10mcg/kg/min)
* Prepare for transcutaneous pacing: use without delay for high degree blocks (Type II second degree block or 3rd degree AV block)
* Consider CVL, arterial line
Vivek K Moitra, Andrea Gabrielli, Gerald A Maccioli, Michael F O’Connor Anesthesia advanced circulatory life support. Can J Anaesth: 2012, 59(6);586-603