Atropine test and circulatory arrest in the fossa posterior assessed by transcranial Doppler.
OBJECTIVE
To evaluate whether a negative atropine test (i.e., increase in heart rate of less than 3% after intravenous administration of 3 mg atropine) correctly predicts circulatory arrest in the fossa posterior during craniocaudal herniation in patients with primary supratentorial lesions.


METHODS
Prospective, observational clinical study.


METHODS
Two surgical intensive care units in a university hospital.


METHODS
In 45 consecutive patients with suspected brain death, an atropine test (AT) and a transcranial Doppler sonography were performed simultaneously and, if necessary, repeatedly.


RESULTS
Forty-four patients fulfilled the typical criteria of a supratentorial and infratentorial circulatory arrest as the atropine test became negative. In one patient, who had undergone a decompressive craniectomy for uncontrollable intracranial pressure 4 h prior to the AT testing, we found a negative AT in the presence of an antegrade supratentorial and infratentorial flow.


CONCLUSIONS
A negative atropine test indicates a circulatory arrest in the fossa posterior in patients with primary supratentorial lesions and craniocaudal herniation. In patients with brain-stem lesions, however, a negative atropine test does not unequivocally indicate a circulatory arrest.
Hüttemann
E
E
Department of Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Germany. Egbert.Huettemann@med.uni-jena.de
Schelenz
C
C
Sakka
S G
SG
Reinhart
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine / Q000008:administration & dosage*; D001926:Brain Death / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial
D001285:Atropine