Assuntos
Fraturas Mandibulares/complicações , Osso Occipital/diagnóstico por imagem , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico por imagem , Adulto , Humanos , Intubação Gastrointestinal , Masculino , Fraturas Mandibulares/cirurgia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
OBJECTIVE: To determine the heart rate response to atropine (<0.1 mg) in anaesthetised young infants. DESIGN: Prospective, observational and controlled. SETTING: Elective surgery. PATIENTS: Sixty unpremedicated healthy infants less than 15 kg were enrolled. Standard monitoring was applied. Anaesthesia was induced by mask with nitrous oxide (66%) and oxygen (33%) followed by sevoflurane (8%). INTERVENTIONS: Intravenous (IV) atropine (5 µg/kg) was flushed into a fast flowing IV. The ECG was recorded continuously from 30 s before the atropine until 5 min afterwards. MAIN OUTCOME MEASURES: The incidence of bradycardia and arrhythmias was determined from the ECGs by a blinded observer. RESULTS: The median (IQR) age was 6.5 (4-12) months and the mean (95% CI) weight was 8.6 (8.1 to 9.1) kg. The mean (95% CI) dose of atropine was 40.9 (37.3 to 44) µg. Bradycardia did not occur. Two infants developed premature atrial contractions and one developed a premature ventricular contraction. When compared with baseline values, heart rate increased by 7% 30 s after atropine, 14% 1 min after atropine and 25% 5 min after atropine. Twenty-nine infants (48%) experienced tachycardia (>20% above baseline rate) after atropine lasting 222.7 s (range 27.9-286). The change in heart rate 5 min after atropine was inversely related to the baseline heart rate. CONCLUSIONS: The upper 95% CI for the occurrence of bradycardia in the entire population of infants based on a zero incidence in this study is 5%. These results rebut the notion that atropine <0.1 mg IV causes bradycardia in young infants. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov #NCT01819064.
