• E Hüttemann, C Schelenz, S G Sakka, and K Reinhart.
• Department of Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Germany. Egbert.Huettemann@med.uni-jena.de
• Intensive Care Med. 2000 Apr 1; 26 (4): 422-5.

ObjectiveTo evaluate whether a negative atropine test (i.e., increase in heart rate of less than 3% after intravenous administration of 3 mg atropine) correctly predicts circulatory arrest in the fossa posterior during craniocaudal herniation in patients with primary supratentorial lesions.Material And MethodsProspective, observational clinical study.SettingTwo surgical intensive care units in a university hospital.PatientsIn 45 consecutive patients with suspected brain death, an atropine test (AT) and a transcranial Doppler sonography were performed simultaneously and, if necessary, repeatedly.Measurements And ResultsForty-four patients fulfilled the typical criteria of a supratentorial and infratentorial circulatory arrest as the atropine test became negative. In one patient, who had undergone a decompressive craniectomy for uncontrollable intracranial pressure 4 h prior to the AT testing, we found a negative AT in the presence of an antegrade supratentorial and infratentorial flow.ConclusionA negative atropine test indicates a circulatory arrest in the fossa posterior in patients with primary supratentorial lesions and craniocaudal herniation. In patients with brain-stem lesions, however, a negative atropine test does not unequivocally indicate a circulatory arrest.

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