• Marieke Poterman, Scheeren Thomas W L TWL, Marieke I van der Velde, Pieter L Buisman, Silvie Allaert, Struys Michel M R F MMRF, and Alain F Kalmar.
• From the Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (MP, TWLS, MIVDV, PLB, MMRFS, AFK), Department of Anesthesia and Critical Care Medicine, Maria Middelares Hospital (SA, AFK); and Department of Anesthesia, Ghent University, Ghent, Belgium (MMRFS).
• Eur J Anaesthesiol. 2017 Oct 1; 34 (10): 695-701.

BackgroundInduction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine.ObjectiveTo investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia.DesignA double-blind, randomised controlled trial.SettingSingle-centre, University Medical Center Groningen, The Netherlands.PatientsSixty euvolaemic patients scheduled for surgery under general anaesthesia.InterventionsAnaesthesia was induced and maintained with a target-controlled infusion of propofol with a target effect-site concentration (Ce) of 2.5 μg ml, remifentanil (target-controlled infusion), (Ce 8 ng ml) and cis-atracurium. Methylatropine (500 μg) or 0.9% saline was administered at immediately before induction of anaesthesia.Main Outcome MeasuresThe changes (Δ) in mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), rate pressure product, cerebral tissue oxygenation and peripheral tissue oxygenation between induction of anaesthesia (T0) and 10 min later (T10).ResultsAtropine significantly attenuated the changes in the outcome measures between T0 and T10. Median (inter-quartile range) changes were MAP, Δ = -24 (-40 to -21) vs. Δ = -37 mmHg (-41 to -31) (P = 0.02); HR, Δ = 0 ± 13 vs. -19 ± 11 bpm (P < 0.01); CI, Δ = -0.4 ± 0.7 vs. -0.9 ± 0.6l min m (P < 0.01) and rate pressure product, Δ = -3241 (-5015 to -613) vs. Δ = -5712 mmHg min (-6715 to -3917) (P < 0.01). Cerebral tissue oxygenation and peripheral tissue oxygenation did not change in either group. Maximum HR after atropine was 102 (86 to 116) vs. 85 bpm (76 to 95).ConclusionAdministration of atropine, before induction of anaesthesia with propofol and high-dose remifentanil, can significantly reduce the decreases in HR, MAP and CI.Trial RegistrationClinicaltrials.gov identifier: NCT01871922.

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