Bradycardia after the use of atracurium

Four cases of severe bradycardia developed during surgery in patients given the neuromuscular blocking agent atracurium as part of the anaesthesia. In all cases sinus rhythm was restored by giving intravenous atropine. It is recommended that in all operations in which vagal stimulation is expected patients should be given atropine as part of the premedication or induction sequence and should undergo full electrocardiographic monitoring during surgery.