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Oral atropine enhances the risk for acid aspiration in children
T Randell1, L Saarnivaara, M Oikkonen
1Department of Anaesthesia, Helsinki University Central Hospital, Finland.
Insights
Comparing oral atropine and intravenous glycopyrrolate in children for adenoidectomy, this study found both anticholinergic drugs had similar antisialagogue effects. Gastric volume and pH risk factors were reduced with glycopyrrolate.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
Background:
- Anticholinergic drugs are used to reduce secretions during anesthesia.
- Optimizing preoperative medication is crucial for pediatric surgical safety.
- Comparing different administration routes and drugs can improve patient outcomes.
Purpose of the Study:
- To compare the efficacy of oral atropine versus intravenous glycopyrrolate in healthy children undergoing adenoidectomy.
- To assess the impact of these anticholinergic drugs on gastric volume and pH.
- To evaluate the antisialagogue effect of both drug administration methods.
Main Methods:
- A double-blind, randomized study involving 58 healthy children undergoing adenoidectomy.
- Children received midazolam premedication.
- Group A received oral atropine (0.03 mg/kg), while Group G received intravenous glycopyrrolate (0.005 mg/kg).
- Gastric volume, pH, and antisialagogue effect were assessed.
Main Results:
- The antisialagogue effect was similar in both the oral atropine and intravenous glycopyrrolate groups.
- Fewer children in the intravenous glycopyrrolate group had increased gastric volume (10 vs 19) and low gastric pH (14 vs 23) compared to oral atropine.
- The combined risk factors of low gastric pH and high gastric volume were also less frequent in the glycopyrrolate group (9 vs 17).
Conclusions:
- Intravenous glycopyrrolate may offer a better safety profile regarding gastric contents compared to oral atropine in pediatric adenoidectomy.
- Both anticholinergic drugs provide comparable reduction in secretions.
- Further research could explore optimal dosing and timing for preoperative anticholinergic use in pediatric surgery.
Abstract:
Two modes of administration of an anticholinergic drug were compared in 58 healthy children undergoing adenoidectomy. The study was double-blind and randomized. All children were premedicated with oral midazolam 0.5 mg/kg. Twenty-nine children received oral atropine 0.03 mg/kg (Group A) and the rest were given i.v. glycopyrrolate 0.005 mg/kg at the induction of anaesthesia (Group G). In Group A, of 29 children, the stomach was empty in 2, pH was less than 2.5 in 23, the gastric volume was greater than 0.4 ml/kg in 19, and both these risk factors were present in 17 children. The same figures in Group G were 5 (NS), 14 (P less than 0.05), 10 (P less than 0.05) and 9 (P less than 0.05) children, respectively. The antisialagogue effect was similar in both groups.