The heart rate response to succinyl-choline in children: A comparison of atropine and glycopyrrolate

Abstract

To determine whether intravenous atropine and glycopyrrolate are equally effective in preventing succinylcholine-induced heart rate changes, we studied the heart rate during the first 78 seconds of anaesthesia in 40 children anaesthetized with either thiopentone, atropine (0.02 mg X kg-1) and succinylcholine (2 mg X kg-1), or thiopentone, glycopyrrolate (0.01 mg X kg-1) and succinylcholine (2 mg X kg-1). Each treatment group was divided into four subgroups which differed only in the interval (6, 10, 15, 20 seconds) between injection of atropine or glycopyrrolate and succinylcholine. During the 54 seconds after succinylcholine, the mean heart rate of each subgroup decreased transiently and then returned to the pre-induction heart rate or higher. There was no difference in either the magnitude or the duration of the decrease in heart rate or the subsequent increase in heart rate between respective subgroups. Bradycardia occurred in only two patients, both of whom received glycopyrrolate. We conclude that atropine (0.02 mg X kg-1) and glycopyrrolate (0.01 mg X kg-1) are equally effective in attenuating succinylcholine-induced changes in heart rate in children.

Should the routine use of atropine before succinylcholine in children be reconsidered?

“…7 Previous studies have also varied in their definitions of bradycardia. 2,3,12 The low incidence of succinylcholine-induced bradycardia in this study may be attributable to several factors. Firstly, the oxygen saturation and the end-tidal carbon dioxide were maintained within normal limits.…”

“…2,7,8,12,13 These included heavy sedative premedication which may have predisposed the children to unrecognised hypoxia and frequent use of cyclopropane which is a particularly arrythmogenic agent. Other factors which may have increased the incidence of arrythmias included the combination of halogenated hydrocarbon volatile agents with circulating catecholamines, ~4 laryngoscopy and intubation in the presence of "light" anaesthesia, t5 hypercarbia and hypoxia.…”

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

“…The effect of glycopyrrolate in preventing bradyarrhythmias is dose related. 23 We used a relatively small dose of glycopyrrolate (0.004 mg kg 91 ) to study its effectiveness in preventing bradycardia. The effect of glycopyrrolate on haemodynamic variables was moderate compared with that of atropine.…”

The Pharmacology of Airway Management in Critical Care

“…This is particularly common in children. 29 In adults, bradycardia is commonly seen if a second dose of succinylcholine is administered. It is advisable to co-administer atropine with a second dose.…”