[HSF] cordarone toxicity

[psimha]

The entity exists but it is not so common as to preclude its use for all 
patients. A large volume of my cases involve afib surgery and I 
routinely use Cardarone in them. I have only one caveat - which I learnt 
from one mistake - any lung problem wrt oxygenation - stop Cardarone 
immediately. After this I have luckily not had any major problems.Not 
giving Cardarone at all is (jocularly) throwing the baby out with the 
bath water. It is a versatile and useful drug if used with care.
My routine is to give 150 - 300 mg on pump and 450 mg in 50 ml over 24 
hrs followed by Tab Cardarone 200 mg o.d. This dosage seems to cause the 
least hemodynamic problems. An occasional patient with VT may receive 
higher doses but I tend to add an additional anti arrhythmic agent 
rather than scaling up Cardarone rapidly.

Prasanna

Giuseppe Rescigno wrote:

>You probably found in the literature anecdotical cases of cordarone-related ARDS post-CPB. It seems that the preoperative treatment, followed by CPB, determines a serious impairement of pulmonary endothelial function. I have never seen it but this is one of the reasons of my reluctancy in using cordarone ad preventive measure anti-Afib.
>
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>On Friday, June 03, 2005, at 03:39AM, M. Andre Vasu <mavasu at comcast.net> wrote:
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>>A 90 you man viable individual undergoes MV repair,Maze and Lima to Lad.Postop pt is stable with excellent cardiac output,ABGs and FIO2 40 percent.The evening of surgery he goes into Afib and is started on Cordarone drip.Within two hours he is on 100 % O2 in florid respiratory failure.Agreement with family to place SciMed oxigenator for 48 hours only.He does not recover and dies.
>>Autopsy shows MV repaired Lima patent and lungs congested.
>>Acute pulmonary toxicity in ICU setting has been reported but is rare.Pt had prior exposure to the drug.
>>Any experience among members and advice as to treatment.
>>M.Andre Vasu
>>Punta Gorda,Fl
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>Giuseppe Rescigno M.D.
>Cardiothoracic Surgeon
>
>Lancisi Hospital
>Torrette - Ancona
>Italy
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