Cardiovascular Anesthesia — MCQs

Q: Which of the following is NOT a treatment for supraventricular tachycardia with hypotension in a patient under general anesthesia?

Verapamil 5 mg IV. ### Explanation The management of intraoperative supraventricular tachycardia (SVT) depends primarily on the patient's **hemodynamic stability**. **1. Why Verapamil is the Correct Answer (The "NOT" treatment):** In a patient with SVT and **hypotension** (hemodynamic instability), calcium channel blockers like Verapamil are **contraindicated**. Verapamil has potent negative inotropic and vasodilator properties. Administering it to a hypotensive patient can cause a further drop in systemic vascular resistance and myocardial contractility, potentially leading to cardiovascular collapse or cardiac arrest. **2. Analysis of Other Options:** * **Direct Current (DC) Cardioversion (Option C):** This is the **treatment of choice** for any tachyarrhythmia causing hemodynamic instability (hypotension, altered mentation, or pulmonary edema) under general anesthesia. Synchronized cardioversion (starting at 50-100J) provides immediate rhythm correction. * **Adenosine (Option B):** If the patient is unstable but IV access is immediately available, Adenosine (6mg, then 12mg) can be attempted as it has an ultra-short half-life and may terminate the reentry circuit without prolonged hemodynamic depression. * **Carotid Sinus Massage (Option A):** This is a non-invasive vagal maneuver that can be attempted quickly to increase vagal tone and slow AV node conduction while preparing for cardioversion. **Clinical Pearls for NEET-PG:** * **Unstable Tachycardia:** Always choose **Synchronized DC Cardioversion**. * **Stable SVT:** First-line is Vagal maneuvers, followed by Adenosine (Drug of Choice). * **Verapamil Warning:** Never give Verapamil in wide-complex tachycardias of unknown origin or in patients with WPW syndrome + Atrial Fibrillation, as it can lead to ventricular fibrillation. * **Amiodarone:** Preferred for stable ventricular tachycardia or refractory SVT.

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