Milrinone

-comes premixed from pharmacy at 200 mcg/cc

-loading dose 50 mcg/kg over 10-20 min
-then 0.5 mcg/kg/min
-EASYCALC:
(0.5 mcg/kg/min * bodyweight/200)* 60 = cc/hour

Bretylium (Bretylol)
-Initially 5 mg/kg, repeat 10 mg/kg if needed
-Infusion 500 mg in 50 cc D5W (10 mg/ml) at 1-3 mg/min (7-21 cc/hr)

LidocaineDrip
2gm /250 cc (8 mg/ml);1-4 mg/min (7-30 cc/hr)

Procainamide(Pronestyl)
Bolus:100 mg IV q 10 minutes or
Drip: 2 grams/250 ml D5W (8 mg /ml)
-run infusion at 20 mg/min (150 cc/hr) until:
1) QRS or PR widens >50%, or
2) Dysrhythmia suppressed, or
3) Hypotension, or
4) Total of 17 mg/kg or 1000 mg infused
Then 2-6 mg/min (15-45 cc/hr)

Cardizem Drip
(for free radial artery grafts)
-mix 125 mg in 100c NaCl bag with additional 25 cc NaCl
-run @ 2mg/hr (2cc/hr) if started on patient warming

Nitric Oxide (inhaled)

Cam Clark 7/8/99
-therapeutic range 20-80 ppm; no increased benefit from higher concentration
-once started, must wean gradually to avoid rebound
Toxicity of NO2 - Methemoglobinemia; rarely an issue clinically
- circuit: essentially a modified BAIN

Vasopressin Drip
1/13/99

• often used to provide increased SVR during milrinone administration

• 100 units vasopressin/100 cc
• comes from pharmacy pre-mixed
• run @ 2.4 cc/hr (0.04 units/min)
• dose is NOT weight dependent
convert IVAC multi-channel pump to neonatal to allow decimals in rate (More Options-> Device->Neonatal)

Insulin Drip for Heart Cases

2/14/99- Cam Clark

• mix 100 units of reg Insulin in 100 ml NS

• for BS > 350, bolus 15 units and run infusion at 5 units/hr.
• for BS > 270 and < 350, bolus 10 units and run infusion at 4 units/hr.
• Obviously a carrier will be required with the INS infusion.
Amiodarone (Cordarone®) Protocol 3/99
**for ventricular arrhythmias, and atrial fibrillation prophylaxis;
**May cause dramatic hypotension with concurrent alpha blockade

• order the solution from the pharmacy:

-150mg /100ml parfill bag
-900mg /500 ml glass bottle (1.8mg/ml)
-multichannel pump, extension set
• BOLUS (Loading) Dose: (Bag)
o 150mg (100ml) over 10 minutes
• MAINTENANCE Dose: (Bottle)
o 33 ml/hr (60mg /hr)
o after 6 hours: decrease rate to 17 ml/hr (30 mg/hr)