Prophylactic administration of atropine attenuates the negative haemodynamic effects of propofol/remifentanil induction of anaesthesia.

Marieke Poterman, Thomas Scheeren, M.I. van der Velde, Michel Struys, A.F. Kalmar

Research output: Contribution to conferenceAbstractAcademic

Abstract

Background and Goal of Study: 
Induction of anaesthesia with propofol and remifentanil often induces unwanted bradycardia and hypotension. This raises the concern for preserving haemodynamic stability and adequate tissue oxygenation. We previously demonstrated that atropine significantly improves haemodynamics and tissue oxygenation during propofol/remifentanil anaesthesia.The aim of this study is to investigate if prophylactic administration of atropine at induction of anaesthesia can attenuate these negative haemodynamic effects and thus maintain tissue oxygenation.

Materials and Methods: 
After local IRB approval and written IC, 35 patients were included in a preliminary analysis of this double blind, randomised controlled trial. MAP, HR and CI were continuously recorded with the Nexfin device (Edwards Lifesciences BMEYE). The FORE-SIGHT® (CASMED) and InSpectra™ (Hutchinson Technology) oximeters monitored cerebral (SctO2, forehead) and peripheral (SptO2, thenar) tissue oxygenation, respectively. Euvolemia was pursued by infusion of 500ml colloid solution prior to anaesthesia, which was induced with remifentanil TCI, propofol TCI, and cis-atracurium. According to randomisation methylatropine (500µg, 1ml) or saline (1ml) was administered at start of induction of anaesthesia.

Results and Discussion: 
Figure 1 shows the evolution of the studied variables 1 minute before the induction of anaesthesia until 11 minutes thereafter of 17 saline and 18 atropine patients respectively, as well as values of relative changes at 10 minutes. Atropine prophylaxis resulted in better haemodynamics with a significantly higher MAP, HR and CI compared to the saline group. There was no intergroup difference in tissue oxygenation. 

Conclusions: 
Prophylactic administration of atropine at induction of remifentanil/propofol anaesthesia is an effective approach to anticipate its negative haemodynamic effects. This approach maintains tissue oxygenation and may prevent the requirement of additional perioperative vasoactive medication.

References:
1. Washington ASA congress 2012: A840.
Original languageEnglish
Pages4AP7-3
Publication statusPublished - 3-Jun-2013
EventEuroanaesthesia 2013 - Barcelona, Spain
Duration: 1-Jun-20134-Jun-2013

Conference

ConferenceEuroanaesthesia 2013
CountrySpain
CityBarcelona
Period01/06/201304/06/2013

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