title: Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?
abstract: This study was conducted to examine whether pretreatment with intravenous atropine could prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil in a prospective randomized placebo-controlled manner. Seventy patients, aged 24-78 years, were randomly divided into two groups, and received 0.5 mg atropine or placebo saline 1 min before induction of intravenous anesthesia with remifentanil at 0.4 microg/kg/min, propofol at a target blood concentration of 3 microg/ml, and vecuronium 1.5 mg/kg. Immediately after tracheal intubation, the infusion rate of remfentanil and the target concentration of propofol were reduced to and kept at 0.1 microg/kg/min and 2 microg/ml, respectively, for 10 min. Noninvasive blood pressure (BP) and heartrate (HR) were measured and recorded every minute. Intravenous atropine could prevent a fall in HR, but not a fall in BP, during induction of intravenous anesthesia with propofol and remifentanil of our dosing regimen. Our data suggested that a fall in HR induced by propofol-remifentanil anesthesia was mainly caused by centrally mediated sympatholytic and/or vagotonic actions of propofol and remifentanil, whereas a fall in BP was mainly the result of their direct vasodilating actions.
authors.affiliation: Department of Anesthesiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan. kmaruyam@saitama-med.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Maruyama
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nishikawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Jun
authors.initials: J
authors.lastname: Ariyama
authors.forename: Akira
authors.initials: A
authors.lastname: Kitamura
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hayashida
mesh_terms: D000328:Adult; D000368:Aged; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use*; D001919:Bradycardia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics / Q000008:administration & dosage / Q000627:therapeutic use*; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D010276:Parasympatholytics; D010880:Piperidines; D001285:Atropine; D000077208:Remifentanil; D015742:Propofol