• M A Islam, S M Shahida, M R Islam, M M Haque, and M H Rashid.
• CMH Mymensingh, Bangladesh.
• Mymensingh Med J. 2011 Oct 1; 20 (4): 595-9.

AbstractIt was a prospective comparative clinical study carried out in the Department of Anaesthesia, Combined Military Hospital (CMH), Dhaka, to evaluate the heart rate changes during reversal of neuromuscular blockade by using 3 different doses of atropine (in a mixture with neostigmine) and thereby detect comparatively safer dose. Sixty patients of ASA (American Society of Anesthesiologists) grade I and II physical status were divided equally into 3 groups. Neostigmine 0.05 mg/kg body weight mixed with atropine 0.02, 0.015 and 0.01 mg/kg body weight given intravenously in group A, B and C respectively during reversal. The 3 groups were compared in age, sex, body weight, and ASA grades, but there was no significant difference (p>0.05) between 3 groups. It is revealed that in Group C (atropine at a dose of 0.01 mg/kg with neostigmine), heart rate affected very little but salivary and tracheobronchial secretions were more. One of them had laryngospasm which was managed conservatively. In Group B (who received atropine 0.015 mg/kg) incidence of tachycardia observed was less than Group A (who received atropine 0.02 mg/kg). The patients of this group also had some salivary secretions but less than group C. Tachycardia was most marked in Group A but had minimum salivary secretions. Statistical analysis of heart rate changes in different times among the 3 Groups was significant (p<0.05). It was highly significant (p<0.01) in 1 minute after reversal. So relatively lower dose (0.015 mg/kg) of atropine with neostigmine than the conventional dose (0.02mg/kg) can be used to decrease tachycardia during reversal of neuromuscular blockade especially in haemodynamically unstable patients.

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