A patient with a wide-complex tachycardia after induction for abdominal aortic aneurysm repair is treated most appropriately with which drug given IV over 10 minutes?

A patient with a wide-complex tachycardia after induction for abdominal aortic aneurysm repair is treated most appropriately with which drug given IV over 10 minutes?

• A. Lidocaine
• B. Amiodarone
• C. Adenosine
• D. Verapamil

Answer: (B)

Wide-complex tachycardia in the intraoperative setting is most commonly ventricular tachycardia until proven otherwise. Amiodarone given IV over about 10 minutes is the best choice because it effectively terminates VT and provides ongoing rhythm control with a relatively favorable hemodynamic profile in this context. It works for both monomorphic and polymorphic VT and remains effective even when there’s ischemia or recent induction, which are common during perioperative periods. Adenosine is useful for certain narrow-complex SVTs but has no role in VT and can worsen stability if misapplied. Verapamil is contraindicated in wide-complex tachycardia due to risk of profound hypotension and potential to precipitate collapse in VT or structural heart disease. Lidocaine can treat VT but is less reliable in ischemic or postoperative VT and is not as universally effective as amiodarone. In unstable patients, synchronized cardioversion remains an option, but when a drug is sought, amiodarone is usually the preferred first-line choice.

Wide-complex tachycardia in the intraoperative setting is most commonly ventricular tachycardia until proven otherwise. Amiodarone given IV over about 10 minutes is the best choice because it effectively terminates VT and provides ongoing rhythm control with a relatively favorable hemodynamic profile in this context. It works for both monomorphic and polymorphic VT and remains effective even when there’s ischemia or recent induction, which are common during perioperative periods. Adenosine is useful for certain narrow-complex SVTs but has no role in VT and can worsen stability if misapplied. Verapamil is contraindicated in wide-complex tachycardia due to risk of profound hypotension and potential to precipitate collapse in VT or structural heart disease. Lidocaine can treat VT but is less reliable in ischemic or postoperative VT and is not as universally effective as amiodarone. In unstable patients, synchronized cardioversion remains an option, but when a drug is sought, amiodarone is usually the preferred first-line choice.