ABSTRACT

Objectives: To evaluate the effect of oral atropine premedication in infants attenuates cardiovascular depression during halothane anaesthesia.

Methodology Design and setting: Tertiary care teaching hospital.

Subjects: A double blind study was conducted on 60 patients of paediatric age group of ASA Grade I were divided into Group A(4-9 months) & Group B(10-15 months). Patients of both the groups were randomly placed into premedication subgroups: subgroup I (Placebo), subgroup II (Lo Dose, 0.02mg/kg), subgroup III (Hi Dose, 0.04mg/kg) with 10 patients in each group.

Results: Oral atropine given one hour before the induction of anaesthesia in the doses of 0.02mg/kg and 0.04mg/kg is effective in attenuating cardiovascular depression caused by halothane which is the most commonly used inhalational anaesthetic agent in paediatric patients.

Keywords: Oral atropine, Premedication, Halothane Anaesthesia, Cardiovascular depression.

INTRODUCTION

The exposure of the strange and the unfamiliar environment of operation theatre is invariably a rare experience in ones life and that too under some compulsion caused by some ailment. Where as adult patients can be psychologically prepared by reassurance and drug supplements, the paediatric patients refuse outrightly to accept any explanation. Children imagine and feel the pain of injection, distress of black anaesthesia, face masks & operation in their own way. The drugs play a major role to cause dullness of senses so that the child’s reaction is both acceptable and manageable. A promise, nor mere assurance, that patient will get a sweet syrup rather than a painful prick may be of help. Thus the development of a reliable premedicant is desirable. In addition to quitening the patient, there are few other aims which should be achieved while selecting a premedicant. These are production of amnesia, soothening and facilitation of induction,
maintenance & recovery from anaesthesia, reduction of secretions in oral cavity and respiratory tract, supression of undesirable autonomic reflexes and prevention of post-op vomiting, which has contributed to mortality caused by pulmonary aspiration.

The drugs commonly used prior to anaesthesia are opiates, benzodiazepines, atropine and phenothiazines. Phenothiazines use is associated with salivary suppression, antiemesis and amnesia
but it caused muscle tremors, restlessness, postop pallor and delayed recovery from anaesthesia. Incidence of restlessness & dizziness is more with benzodiazipines but advantage is that it does not delay the recovery and is often followed by a period of amnesia and provides post-op comfort. Belladona alkaloids have been used in anaesthesia for many centuries. Out of these, atropine is most widely used. Though belladona drugs can be used orally, the oral use of atropine is not much in vogue. It is usually admitted by s.c, i.m, i.v routes, though it is
completely absorbed from gatrointestinal tract (small intestine). The gastrointestinal absorption of atropine has also been studied and observed that atropine sulphate is completely ionised upto pH of 7.5 & poorly lipid soluble, High alkalanity of duodenum and small intestine favour rapid absorption. Oral atropine has been used as premedication in children and found to be as effective as atropine given parenterally.

Inhalation of halothane, N 0, and O is the most common method of inducing GA in paediatric patients, but incidence of bradycardia and myocardial depression is almost a consistent finding
in dose related fashion. Because the ventricles of young infant’s heart are not so compliant and the cardiac output is highly dependent on H.R. Blood pressure depends on both C.O. & S.V.R. Infants require increased alveolar concentration of halothane to block the response to a surgical stimulus; thus more prone to cardiovascular depression effects of halothane. Keeping all these points in mind, we need to have a premedicant that can attenuate this cardiovascular depression during halothane anaesthesia. Atropine administration supports cardiac output by increasing H.R. and supports B.P. by maintaining cardiac output. Its antisialagogue and antiemetic actions help in reducing the secretions of saliva & mucous from respiratory tract & prevent post-op nausea & vomiting, thus allowing smooth induction, maintenance & recovery from anaesthesia.

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