title: It is not necessary to administer more than 10 micrograms.kg-1 of atropine to older children before succinylcholine.
abstract: It is common practice at the Hospital for Sick Children, Toronto, to administer atropine 20 micrograms.kg-1 prior to succinylcholine in infants and children. It is unclear whether "prophylactic" administration of this dose of atropine to older children (6-16 yr) is necessary. This study was designed to compare the changes in heart rate, rhythm and mean arterial pressure after administration of either atropine 10 or 20 micrograms.kg-1 with succinylcholine or vecuronium (control group) to older children anaesthetized with thiopentone. Thirty-six ASA I or II patients (6-16 yr) were studied. Anaesthesia was induced with thiopentone 5 mg.kg-1. Patients were randomly assigned to receive: (a) atropine 10 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 12), (b) atropine 20 micrograms.kg-1 and succinylcholine 1.5 mg.kg-1 (n = 13) or (c) vecuronium 0.1 mg.kg-1 (n = 11) to facilitate tracheal intubation. Heart rate and rhythm were recorded continuously using a computerised analogue interface whereas blood pressure was monitored non-invasively before induction of anaesthesia, immediately before and at one and three minutes after laryngoscopy. No difference was observed between patients who received atropine 10 or 20 micrograms.kg-1 prior to succinylcholine. No episode of sinus bradycardia occurred. Premature atrial contractions were observed in two patients (one succinylcholine/atropine 20 micrograms.kg-1, one vecuronium). Administration of atropine 20 micrograms.kg-1 prior to succinylcholine provides no advantage over atropine 10 micrograms.kg-1 in older children in terms of cardiovascular stability.
authors.affiliation: Department of Anaesthesia, Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: G D
authors.initials: GD
authors.lastname: Shorten
authors.forename: B
authors.initials: B
authors.lastname: Bissonnette
authors.forename: E
authors.initials: E
authors.lastname: Hartley
authors.forename: W
authors.initials: W
authors.lastname: Nelson
authors.forename: A S
authors.initials: AS
authors.lastname: Carr
mesh_terms: D000293:Adolescent; D000771:Anesthesia, Intravenous; D001146:Arrhythmia, Sinus / Q000139:chemically induced; D016275:Atrial Function / Q000187:drug effects; D001285:Atropine / Q000008:administration & dosage* / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced; D005117:Cardiac Complexes, Premature / Q000139:chemically induced; D002648:Child; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D013390:Succinylcholine / Q000008:administration & dosage* / Q000494:pharmacology; D013874:Thiopental / Q000008:administration & dosage; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D001285:Atropine; D014673:Vecuronium Bromide; D013390:Succinylcholine; D013874:Thiopental