Atropine: Re-evaluating its use during paediatric RSI

Bean, Alan; Jones, J.S.

doi:10.1136/emj.2007.048512

Cited by 13 publications

(5 citation statements)

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“…Higher success rates are identified in critical care transport crews, who receive regular training to ensure skill retention 26,27 . In regard to rapid sequence intubation, published studies focusing on pediatric drug-assisted intubation (DAI) have various recommendations for medications 28–30 We found that medication recommendations similarly varied in prehospital protocols. States that allowed DAI or another form of medication-assisted intubation were also found to have had varying requirements for certification and additional training.…”

Section: Discussionmentioning

confidence: 96%

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

et al. 2022

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Objective: This study aimed to compare statewide emergency medical services protocols for the management of pediatric respiratory distress. Methods:We performed a descriptive study of emergency medical services protocols for the management of pediatric respiratory distress in the United States, excluding those without model or mandatory protocols. We compared medication recommendations for specific disease processes, including asthma, croup, epiglottitis, anaphylaxis, generalized respiratory distress, intubation, and drug assisted intubation.Results: Thirty-four state protocols were included. All had protocols to address the management of pediatric respiratory distress. There was high agreement in albuterol use for bronchospasm and epinephrine use in anaphylaxis. Epinephrine was recommended in all anaphylaxis protocols, 27 croup protocols (79%), and 3 epiglottitis protocols (9%). Six states (18%) called for albuterol in patients with generalized respiratory distress. Steroid recommendations and indications had variance among states; 26 states (76%) allowed steroid use in patients with asthma, 19 states (56%) recommended steroid use in anaphylaxis, and 11 (32%) recommended steroid use in croup protocols. The route for steroid administration also varied among protocols. Five states (15%) allowed continuous positive airway pressure application in pediatric patients, whereas endotracheal intubation and rapid sequence intubations had varying requirements as well as recommendations for use. Twelve (35%) listed impending or current respiratory failure as an indication, whereas other states had specific markers, such as Glasgow Coma Scale or oxygen saturation, as indications.Conclusions: All included states had specific recommendations for the management of pediatric respiratory distress. There was consistency in recommendations for albuterol use for wheezing and epinephrine use for anaphylaxis. However, there was wide variability in other uses for epinephrine, steroid administration, continuous positive airway pressure use, and specific treatments for croup and epiglottitis. The findings of this study provide a base for important future evidence-based protocol developments and changes in prehospital pediatric respiratory distress treatment.

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Section: Discussionmentioning

confidence: 96%

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

et al. 2022

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“…Atropine allows for increased stimulation of the sinoatrial node by blocking vagal activity and conduction through the cardiac electrical system resulting in the contraction of the cardiac muscle. Because bradycardia is related to anesthesia, paralysis, and direct laryngoscopy is thought to be predominantly vagally mediated, atropine is a natural choice for counteracting these effects (13)(14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Effect of Atropine Administration Before Induction of Anesthesia on the Incidence of Delirium and Other Complications in a Post-anesthesia Care Unit (PACU) Among Children Undergoing Surgery: A Randomized, Placebo-Controlled Clinical Trial

2023

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Background: Considering the lack of studies to investigate the effect of atropine administration on delirium incidence in a post-anesthesia care unit (PACU) in children, this study was conducted with the aim of investigating the effect of atropine administration on delirium incidence and other complications in children undergoing surgery. Methods: The present double-blind, randomized clinical trial was conducted on 70 children aged 1 - 6 years that were candidates for lower abdominal surgery. The patients were assigned to two groups, each consisting of 35 patients. Before induction of anesthesia, 0.02 mg/kg of atropine and 0.02 mg/kg of normal saline were administered intravenously in the first (atropine) and second (control) groups, respectively. Patients’ mean arterial blood pressure (MAP), heart rate (HR), and incidence of complications after surgery were recorded. Results: The results of the present study revealed that the two groups had no significant difference in terms of the mean MAP in any of the studied times (P-value > 0.05). However, the mean HR during surgery was significantly higher in the atropine group compared with the control group (P-value < 0.05). In addition, although the incidence and severity of delirium in the atropine group were insignificantly higher than that of the control group, respiratory complications such as decreased saturation and laryngospasm were lower in the atropine group compared with the control group (P-value > 0.05). The volume of suctioned secretions in the atropine group, with a mean of 6.26 ± 2.47 cc was significantly lower than its volume in the control group, with a mean of 14.57 ± 4.27 cc (P-value < 0.001). Conclusions: According to the findings of the present study, although the administration of atropine slightly increased delirium incidence, it could reduce the incidence of respiratory complications and secretions after surgery. However, more studies are required to make a more definitive conclusion in this respect.

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“…Based on the belief that children have a more pronounced vagal response to intubation, pre-medication with atropine before administra- tion of sedative and paralytic agents has been advocated for the pediatric population (6)(7)(8). Recent literature, however, has demonstrated equivalence in the incidence of vagally mediated bradycardia during laryngoscopy and intubation in pediatric patients who were pre-medicated with atropine vs. those that were not, regardless of the paralytic agent used (9,10). Although there is minimal downside to the use of atropine before intubation, it does cause mydriasis, which can last for hours.…”

Section: Discussion Of Initial Managementmentioning

confidence: 99%