Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?

Abstract

This study was conducted to examine whether pretreatment with intravenous atropine could prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil in a prospective randomized placebo-controlled manner. Seventy patients, aged 24-78 years, were randomly divided into two groups, and received 0.5 mg atropine or placebo saline 1 min before induction of intravenous anesthesia with remifentanil at 0.4 microg/kg/min, propofol at a target blood concentration of 3 microg/ml, and vecuronium 1.5 mg/kg. Immediately after tracheal intubation, the infusion rate of remfentanil and the target concentration of propofol were reduced to and kept at 0.1 microg/kg/min and 2 microg/ml, respectively, for 10 min. Noninvasive blood pressure (BP) and heartrate (HR) were measured and recorded every minute. Intravenous atropine could prevent a fall in HR, but not a fall in BP, during induction of intravenous anesthesia with propofol and remifentanil of our dosing regimen. Our data suggested that a fall in HR induced by propofol-remifentanil anesthesia was mainly caused by centrally mediated sympatholytic and/or vagotonic actions of propofol and remifentanil, whereas a fall in BP was mainly the result of their direct vasodilating actions.

Bradycardia during critical care intubation: mechanisms, significance and atropine: Figure 1

“…Even if induction drugs do not provoke bradycardia, they can have important effects on the circulation by inducing vasodilatation as is the case for propofol,58 59 thiopental58 60 and for the opiates morphine,61 sufentanyl62 and remifentanil 63…”

“…A recent study in adults shows a fall in blood pressure during propofol anaesthesia due to vasodilatation despite atropine use, notwithstanding conservation of the heart rate 59. It is important to bear in mind that there are no similar studies in intensive care to determine if atropine maintains perfusion during intubation where cardiac output and vascular resistance are already compromised.…”

Prophylactic Altropine administration should be considered during laparoscopic surgery

“…Various studies have reported bradycardia and even asystole after use of newer induction agents especially Propofol, Vecuronium and Fentanyl 2,7,8 , but in our study bradycardia was not encountered after use of these drugs (before carboperitoneum creation) probably that was countered by catecholamine surge after airway manipulation. Bradycardia in fourteen patients (30%) presented for laparoscopic surgery after carboperitoneum creation along with use of vagotonic drugs is alarming and careful haemodynamic monitoring and prophylactic management with Atropine sulphate should be considered to minimize morbidities.…”

“…Maruyama K et al used 0.5 mg Atropine sulphate prophylactically to assess bradycardia and hypotension during Propofol, Vecuronium and Ramifentanyl anaesthesia and found that Atropine sulphate could prevent bradycardia but not hypotension during that combination anaesthesia 7 . Takashi H et al reported that Propofol induced bradycardia is diffi cult to treat with higher doses of Atropine as well 8 .…”

Selection of Anesthesia Techniques for the Neonate

“…Propofol enhances parasympathetic activity, which can explain the bradycardia often observed after induction of anesthesia. In adults, the decrease in heart rate after propofol in patients who were also receiving a continuous infusion of remifentanil was abolished by pretreatment with 0.5 mg IV atropine [ 168 ]. Since cardiac output depends to a large extent on heart rate in neonates, a bradycardia will compromise the cardiac output and decrease tissue oxygenation.…”