Describe briefly the pharmacology of adenosine and its potential use in

anaesthesia.

Adenosine is a direct agonist at A1 receptors (Gi protein) coupled to K+ channels

in the SA and AV node, cAMP and hyperpolarizing the membrane. Used
commonly in the diagnosis (AF, flutter) and treatment of paroxysmal SVT (due to
re-entry circuits) during anaesthesia.

Pharmaceutics
 Naturally occuring purine nucleoside
 Clear solution containing 3mg/ml
 Dose – 6 to 12 mg IV given incrementally every 3 minutes

Pharmacokinetics
 Metabolism – Absorbed into RBCs and vascular endothelium where it is
phosphorylated to AMP or deaminated to inosine and hypoxanthine
which are inactive. t1/2 < 10 seconds

Pharmacodynamics
CVS
 Depresses SA and AV nodal activity and conduction velocity, transiently
producing bradycardia +/- AV nodal block, revealing atrial dysrhythmias.
 Infusion may cause vasodilation, SVR, BP
 coronary vasodilation and blood flow via A2 receptors
Resp
 pulmonary vasodilation, PVR
 Bronchospasm
CNS
 Intrathecal adenosine has been shown in animals to  hypersensitivity to
stimuli in presence of central sensitization. Human studies have been
inconclusive.

Side effects
 Facial flushing, headache, dyspnea, chest discomfort

Contraindications
 2nd or 3rd degree HB
 Asthma