Prophylactic atropine administration attenuates the negative haemodynamic effects of induction of anaesthesia with propofol and high-dose remifentanil: A randomised controlled trial. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Poterman, Marieke; Scheeren, Thomas W.L.; van der Velde, Marieke I.; Buisman, Pieter L.; Allaert, Silvie; Struys, Michel M.R.F.; Kalmar, Alain F.
• Is Part Of: European journal of anaesthesiology. Volume 34:Issue 10(2017:Oct.)
• Publication Date: 2017-10
• Subjects: Anesthesiology -- Periodicals; Anesthesiology -- Periodicals; Anesthésiologie -- Périodiques; Anesthesiology; Periodicals; Electronic journals; 617.96
• DOI: 10.1097/EJA.0000000000000639
• Languages: English
• ISSNs: 0265-0215

Abstract

Abstract : BACKGROUND: Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension, raising concerns regarding tissue oxygenation. The electrophysiological cardiac effects of remifentanil can be reversed by atropine. OBJECTIVE: To investigate if prophylactic administration of atropine can attenuate the negative haemodynamic effects of propofol and a high dose of remifentanil during induction of anaesthesia. DESIGN: A double-blind, randomised controlled trial. SETTING: Single-centre, University Medical Center Groningen, The Netherlands. PATIENTS: Sixty euvolaemic patients scheduled for surgery under general anaesthesia. INTERVENTIONS: Anaesthesia was induced and maintained with a target-controlled infusion of propofol with a target effect-site concentration ( C e ) of 2.5 μg ml −1, remifentanil (target-controlled infusion), ( C e 8 ng ml −1 ) and cis -atracurium. Methylatropine (500 μg) or 0.9% saline was administered at immediately before induction of anaesthesia. MAIN OUTCOME MEASURES: The changes (Δ) in mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), rate pressure product, cerebral tissue oxygenation and peripheral tissue oxygenation between induction of anaesthesia ( T 0 ) and 10 min later ( T 10 ). RESULTS: Atropine significantly attenuated the changes in the outcome measures between T 0 and T 10 . Median (inter-quartile range) changes were MAP, Δ = −24 (−40 to −21) vs. Δ = −37 mmHg (−41 to −31) ( P = 0.02); HR, Δ = 0 ± 13 vs. −19 ± 11 bpm ( P < 0.01); CI, Δ = −0.4 ± 0.7 vs. −0.9 ± 0.6l min −1 m −2 ( P < 0.01) and rate pressure product, Δ = −3241 (−5015 to −613) vs. Δ = −5712 mmHg min −1 (−6715 to −3917) ( P < 0.01). Cerebral tissue oxygenation and peripheral tissue oxygenation did not change in either group. Maximum HR after atropine was 102 (86 to 116) vs. 85 bpm (76 to 95). CONCLUSION: Administration of atropine, before induction of anaesthesia with propofol and high-dose remifentanil, can significantly reduce the decreases in HR, MAP and CI. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01871922.