Book Text

RESUSCITATION DRUGS

Table 59-5 lists drugs and the usual starting doses used during resuscitation of the newborn. Birchfield

Figure 59-11 Closed chest massage. For simplification, ventilation is not shown. (From Gregory GA: Resuscitation of the newborn. Anesthesiology 43:225, 1975.)

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**TABLE 59-5** -- Drugs used during resuscitation
Drug	Indication	Dose^*	Route	Response	Complications
Atropine	Bradycardia	0.03 mg/kg	IV	Increased heart rate	Marked tachycardia, diminished cardiac output
Calcium gluconate	Low cardiac output	100 mg/kg over 5–10 minutes (ECG monitoring)		Improved cardiac arrhythmias	Bradycardia
Epinephrine	Flat-line ECG	0.1 mL/kg of a 1:10,000 solution	IV	Flat-line ECG converted to some rhythmic response	Hypertension; ventricular fibrillation
Isoproterenol	Bradycardia, hypotension, low cardiac output	4 mg/250 mL of 5% dextrose; start at 0.01 µg/kg/min and increase until heart rate increases	IV	Increased heart rate, improved cardiac output	Arrhythmias, low cardiac output if heart rate more than 180–220/min
Dopamine	Hypotension	40 mg/100 mL; start at 5 µg/kg/min and increase until desired effect is achieved	IV	Increased arterial pressure; improved cardiac output, perfusion, and urine output	Arrhythmias (uncommon)

*In general, doses given are starting doses and may have to be increased. Most drugs tend to be more effective when the pH > 7.15. ECG, electrocardiogram.

and colleagues^[104] reviewed the use of drugs in neonatal resuscitation. Severe acidosis (pH <7.0) may decrease the effectiveness of these drugs. The pH should be raised above 7.20 as soon as possible. All drugs should be infused in the smallest volume of fluid possible to reduce the risk of inducing hypervolemia. To do so, drugs such as isoproterenol must be administered in high concentrations (16 µg/mL). The dead space of the catheter is filled with the same concentration of the drug, and if the contents of the catheter are flushed into the patient by infusing fluid or another drug, serious cardiac arrhythmias or cardiac arrest may occur. To avoid these complications, the dead space of the catheter and stopcock should be cleared by withdrawing 1.5 mL of blood and fluid. It is preferable to infuse potent cardiac and vasoactive drugs into a separate intravenous line if possible.

Hyperglycemia can significantly augment the effects of hypoxia on ischemia.^[105] It increases the extent of CNS damage and reduces the survival of patients who can be resuscitated from cardiac arrest.^[106] ^[107] Consequently, glucose should be given only to neonates who are hypoglycemic. The blood glucose concentration should be measured by using a glucometer. If the blood glucose concentration is low, the physician should give a bolus of glucose (0.5 to 1.0 mL/kg of 10% dextrose) and begin a constant infusion of 5 to 7 mg/kg/min of glucose. The glucose measurement is repeated in 10 minutes and then as necessary.