Atropine Use in Anesthesia

Introduction to Atropine

The American College of Cardiology recommends atropine for the treatment of symptomatic sinus bradycardia with evidence of low cardiac output and peripheral hypoperfusion 2
The American Heart Association, as published in Circulation, notes that atropine prevents or eliminates bradycardia or asystole produced by vagal stimulation, with a bimodal response of the sinoatrial node to atropine, where smaller doses (<0.5 mg) may be associated with slower frequencies, while larger doses produce acceleration 1

The American College of Cardiology recommends an initial dose of 0.5-1.0 mg IV for bradycardia, repeated every 3-5 minutes as needed, up to a maximum total dose of 2.5 mg 2
The American Academy of Pediatrics recommends a dose of 0.02 mg/kg IV/IO for children, with a minimum dose of 0.1 mg and a maximum dose of 0.5 mg for children and 1.0 mg for adolescents 3
The American Academy of Pediatrics also recommends that the dose can be repeated every 5 minutes, up to a maximum total dose of 1 mg for children and 2 mg for adolescents 3

The Journal of the American College of Cardiology notes that the onset of action after IV administration is within 3 minutes, with a maximum effect observed within this timeframe 4

The American College of Cardiology recommends atropine for the treatment of symptomatic sinus bradycardia with evidence of low cardiac output and peripheral hypoperfusion 2
The American Academy of Pediatrics recommends atropine for the prevention of bradycardia induced by anesthetics 3
The American Heart Association, as published in Circulation, notes that atropine is used for the treatment of bradycardia induced by anesthesia 1

The Journal of the American College of Cardiology notes that doses less than 0.5 mg may occasionally provoke a parasymphaticomimetic response with paradoxical slowing of the heart rate 5
The American Heart Association, as published in Circulation, notes that atropine can be associated with re-entry intra-atrial or sinus pauses in rare cases 1

The American Heart Association, as published in Circulation, notes that in patients with heart transplants, atropine in standard doses can result in paradoxical cardiac block or, less frequently, sinus arrest in 20% of cases 1
The American Society of Anesthesiologists recommends that in children, atropine doses should be relatively higher than the commonly used dose of 0.02 mg/kg during resuscitation 6
The American Society of Anesthesiologists also recommends that doses of up to 0.1 mg/kg may be necessary in children to completely resolve the cholinergic crisis 6