Atropine (Atropen)

Anesthesia Implications

Classification: Anticholinergic (Antimuscarinic)
Therapeutic Effects: Increases HR (primary), increases cardiac output, dries secretions
Time to Onset: < 1 min
Time to Peak: 1 – 3 min
Duration: 15-30 min

Contraindications

none per the manufacturer. However, there are some precautions to take:

1. Myasthenia Gravis: If the patient has this condition, Atropine should be avoided as it could cause a cholinergic crisis
2. Renal / Hepatic Impairment: this would give pronounced/prolonged effects of atropine.
3. Cardiac patients: be particularly careful of anything that would place greater demand on the heart. This would be particularly true in patients with Aortic Stenosis

Primary Considerations

This is the most potent of the anticholinergic drugs to increase HR. The primary reservation is that it crosses the blood-brain barrier and can cause sedation, delirium, and at high doses, anticholinergic syndrome.

Atropine may increase intraocular pressure (IOP) by more than 6 mm Hg in 8% of adults. This does not appear to be the case in pediatric patients 3 years old and younger.

Atropine is a bronchodilator (often given to asthmatic patients for this reason).

Atropine has NO effect on nicotinic receptors responsible for weakness/paralysis.

Drug interactions:
Ephedrine, Glycopyrrolate, Opioids: May enhance the effects of these drugs
Nitroglycerine: Decreases the absorption of this drug
Metoclopramide & other prokinetics: Atropine may diminish the effects of these drug
Glucagon: may enhance the adverse/toxic effects of glucagon

OB: Crosses the placenta. Trace amounts can be found in breast milk.

IV push dose

Bradycardia popular dose: 10-20 ug/kg (0.01 – 0.02 mg/kg).
Oculocardiac reflex dose: 15 – 20 ug/kg.
ACLS bradyarrhythmias/pauses dose: 1.0 mg IV (can be repeated up to 0.04 mg/kg)

Method of Action

Blocks acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS

Elimination

Renal