The Use of Intravenous Atropine After a Saline Infusion in the Prevention of Spinal Anesthesia-Induced Hypotension in Elderly Patients

Abstract

We investigated the efficacy of IV atropine for preventing spinal anesthesia-induced hypotension in elderly patients. Seventy-five patients undergoing transurethral prostate or bladder surgery were randomized to receive either placebo (n ϭ 25), atropine 5 g/kg (smalldose atropine, n ϭ 25) or atropine 10 g/kg (large-dose atropine, n ϭ 25) after the induction of spinal anesthesia. All the patients received an IV infusion of 10 mL/kg 0.9% normal saline over 10 min before the induction of anesthesia. The systolic blood pressure decreased in all three groups after spinal anesthesia. There was a significant increase in the mean heart rate in both atropine groups as compared to the placebo group (placebo group: 78 bpm, 95% confidence interval [CI]: 76.6 -78.5; smalldose atropine group: 86 bpm, 95% CI: 83.9 -88.8; largedose atropine group: 97 bpm, 95% CI: 94.5-100.3; P ϭ 0.001). There was a significant decrease in the incidence of hypotension in patients who received atropine (placebo group: 76%, small-dose atropine group: 52%, large-dose atropine group: 40%, P ϭ 0.03). The mean dose of ephedrine required was significantly decreased in the atropine groups (placebo group: 12.2 mg [sdϭ 10.5], small-dose atropine group: 7.4 mg [sdϭ 10.0], large-dose atropine group: 5.4 mg [sdϭ 8.7 mg], P ϭ 0.048). The total amount of IV fluid and number of patients requiring metaraminol in addition to 30 mg of ephedrine were not significantly different among the three groups. Significant side effects, such as confusion, ST segment changes or angina were not detected in any of the patients. We conclude that IV atropine may be a useful supplement to the existing methods in preventing hypotension induced by spinal anesthesia.

Factors influencing intraoperative bradycardia in adult patients

“…Therefore, atropine premedication attenuated the incidence of bradycardia during the entire period of the operation, even though it was given only once, in the patients' ward. Many earlier studies have already shown the effectiveness of atropine pretreatment to prevent bradycardia during spinal anesthesia [6] or epidural anesthesia [7]. These reports also support the long action of atropine pretreatment during surgery.…”

Prophylactic use of IV atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly: a randomized controlled trial

“…IV atropine after a crystalloid infusion in patients undergoing SA could increase HR very quickly in a dosedependent manner and decrease the incidence of significant hypotension also in a dose-dependent manner [15]. PUN Nze [16] demonstrated the incidence and severity of hypotension were reduced in parturients undergoing cesarean section under spinal anesthesia with use of prophylactic intravenous bolus of atropine.…”

Rate, Predictors, and Consequences of Hemodynamic Depression After Carotid Artery Stenting

“…Pharmacologic pre-treatment is also not benign. The routine use of atropine, especially in an elderly population with coronary artery disease, may lead to potential complications, including confusion, urinary retention (27), and arrhythmias (28). To date, no study has been performed to determine whether aggressively treating patients who develop "mild" HD may prevent persistent HD and thus reduce potential adverse vascular events.…”