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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 Effects:

1 - 3 min

Duration:

15-30 min

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.

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

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


Reference

Barash. Clinical anesthesia. 7th edition. 2013.
UpToDate. Retrieved from www.uptodate.com. 2018.
Urman. Pocket Anesthesia. 2009
Wu. Does atropine use increase intraocular pressure in myopic children? 2012.