• Arch. Dis. Child. · Jul 2015

    Clinical Trial Observational Study

    Do small doses of atropine (<0.1 mg) cause bradycardia in young children?

    • Lara Eisa, Yuvesh Passi, Jerrold Lerman, Michelle Raczka, and Christopher Heard.
    • Department of Anesthesiology, Women and Children's Hospital of Buffalo, Buffalo, New York, USA.
    • Arch. Dis. Child. 2015 Jul 1; 100 (7): 684-8.

    ObjectiveTo determine the heart rate response to atropine (<0.1 mg) in anaesthetised young infants.DesignProspective, observational and controlled.SettingElective surgery.PatientsSixty unpremedicated healthy infants less than 15 kg were enrolled. Standard monitoring was applied. Anaesthesia was induced by mask with nitrous oxide (66%) and oxygen (33%) followed by sevoflurane (8%).InterventionsIntravenous (IV) atropine (5 µg/kg) was flushed into a fast flowing IV. The ECG was recorded continuously from 30 s before the atropine until 5 min afterwards.Main Outcome MeasuresThe incidence of bradycardia and arrhythmias was determined from the ECGs by a blinded observer.ResultsThe median (IQR) age was 6.5 (4-12) months and the mean (95% CI) weight was 8.6 (8.1 to 9.1) kg. The mean (95% CI) dose of atropine was 40.9 (37.3 to 44) µg. Bradycardia did not occur. Two infants developed premature atrial contractions and one developed a premature ventricular contraction. When compared with baseline values, heart rate increased by 7% 30 s after atropine, 14% 1 min after atropine and 25% 5 min after atropine. Twenty-nine infants (48%) experienced tachycardia (>20% above baseline rate) after atropine lasting 222.7 s (range 27.9-286). The change in heart rate 5 min after atropine was inversely related to the baseline heart rate.ConclusionsThe upper 95% CI for the occurrence of bradycardia in the entire population of infants based on a zero incidence in this study is 5%. These results rebut the notion that atropine <0.1 mg IV causes bradycardia in young infants.Trial Registration NumberClinicalTrials.gov #NCT01819064.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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