Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children

Abstract

We studied the effect of anticholinergics on the incidence of cardiac arrhythmias during paediatric anaesthesia. ASA I-II children (n = 77) undergoing adenoidectomy were randomly allocated to three groups. Intravenous atropine 0.02 mg kg-1 was given in group A (n = 25), glycopyrrolate 0.004 mg kg-1 in group G (n = 27) and physiological saline in group P (n = 25) 3 min before the induction of anaesthesia. The children breathed spontaneously under halothane anaesthesia with 66% nitrous oxide in oxygen after induction with thiopentone and succinylcholine. Perioperative monitoring of the ECG (Holter recordings) and oxygen saturation was carried out. Ventricular tachycardia occurred in 16.0%, 18.5% and 12.0% of the children in groups A, G and P respectively (ns). The incidence of ventricular arrhythmias (ventricular tachycardia, ventricular bigeminy, ventricular premature beats > 10) was 20.0% in group A, 44.4% in group G and 36.0% in group P (ns). Bradycardia (< 70 beats min-1) was observed in 0.0%, 14.8% and 24.0% of patients in groups A, G and P respectively (A vs P, P < 0.05). The use of anticholinergics did not influence the incidence of ventricular arrhythmias during halothane anaesthesia in children. Bradycardia was more common in the placebo group than in the atropine group.

Current Medication Practice and Tracheal Intubation Safety Outcomes From a Prospective Multicenter Observational Cohort Study*

“…One recent Australian/New Zealand study employing a web-based survey of 28 neonatal ICUs similarly reported varying use of premedication (27). Several investigators have evaluated the protective effect of atropine on preventing dysrhythmia in the pediatric and neonatal populations (25,(28)(29)(30)(31). Jones et al (29) evaluated the effect of atropine in relation to new onset dysrhythmia in the peri-intubation period during transport and in PICU settings.…”

Induction characteristics of thiopentone/suxamethonium, propofol/alfentanil or halothane alone in children aged 1–3 years

“…In earlier studies, bradycardia or junctional rhythm occurred in 19-29% of children after use anticholinergics as we wanted to investigate the sole effect of the induction method on the occurrence induction with propofol [9]. In the study by Annila et al, [31] the use of anticholinergic drugs did on injection with propofol. All the cases of bradycardia were transient and subsided quickly without the need for anti-junctional rhythm in 4-11% [8,9] and ventricular extrasystoles in 22% of children [8].…”

Hypoglycemia associated with dexmedetomidine overdose in a child?

“…The maintenance fluids could have contained glucose to add substrate after a long fast such as described above. It is still debated whether patients should have routine dosing of glycopyrrolate [13,14]. In this patient, glycopyrrolate might have attenuated the bradycardia.…”