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I do not want to resurrect a thread that has hopefully recently been laid to rest but the International Guidelines (pause whilst I duck in case any flack is thrown) now recommend a starting dose of 6 mg followed by two further doses of 12 mg if necessary. I have not seen any recommendations for any larger dosages than this. Vagal manoeuvres are worthwhile (get the patient to blow in to the narrow end of a 20 ml syringe in order to push back the plunger – far less complicated than explaining the valsalva manouvere but equates to the same thing) but the majority of SVT patients in A&E are professionals (i.e. they’ ve tried every trick in the book and have reluctantly come in for the adenosine). I usually ask them what dose worked the last time – if 3mg worked (and I have never seen that dose work myself), I try that otherwise I start at 6 mg. Andy -----Original Message----- From: The list will be of relevance to all trainees including undergraduates and [mailto:[log in to unmask]]On Behalf Of Mandar Marathe Sent: 16 January 2001 07:13 To: [log in to unmask] Subject: adenosine in SVT > Worked and she's we;; so it quite good. Another thing > .... has anyone ever seen 3mg work...I never have I > usually just start at 6mgs. The most reliable dose > seems to be 12mg. > What's other folks experience. > Iain Never seen 3mg doing anything! Some people say 6-12-18 (-18) mg which is the general direction I'm heading. I don't usually bother with vagal manoeuvres. Do they really work in the A&E setting?