What is the protocol for administering an atropine (antimuscarinic) drip?

From the Guidelines

Atropine should be administered as a continuous intravenous drip for specific clinical situations, particularly in managing severe bradycardia, starting at 0.3-0.6 mg/hour (75-150 mcg/hour), titrating to heart rate response, with caution in patients with acute coronary ischemia or MI, as increased heart rate may worsen ischemia or increase infarction size 1. The recommended protocol for administering an atropine drip involves preparing a solution of 1 mg of atropine in 250 mL of normal saline (concentration 4 mcg/mL) and starting at a dose of 0.3-0.6 mg/hour (75-150 mcg/hour), with titration to heart rate response, as the goal is to maintain a heart rate above 60 beats per minute while avoiding tachycardia 1. Some key points to consider when administering an atropine drip include:

• Continuous cardiac monitoring is essential during administration
• The infusion should be adjusted to maintain heart rate above 60 beats per minute while avoiding tachycardia
• Watch for anticholinergic side effects including dry mouth, blurred vision, urinary retention, and confusion
• Atropine works by blocking acetylcholine at muscarinic receptors, preventing parasympathetic stimulation and allowing sympathetic influence to predominate, which increases heart rate and conduction through the AV node
• Use atropine cautiously in the presence of acute coronary ischemia or MI; increased heart rate may worsen ischemia or increase infarction size 1. It is also important to note that atropine administration should not delay implementation of external pacing for patients with poor perfusion, and that doses of atropine sulfate of <0.5 mg may paradoxically result in further slowing of the heart rate 1.

From the FDA Drug Label

For intravenous administration. ( 2). Titrate according to heart rate, PR interval, blood pressure and symptoms. ( 2) Adult dosage Antisialagogue or for antivagal effects: Initial single dose of 0. 5 to 1 mg. ( 2) Antidote for organophosphorus or muscarinic mushroom poisoning: Initial single dose of 2 to 3 mg, repeated every 20 to 30 minutes. ( 2) Bradyasystolic cardiac arrest: 1 mg dose, repeated every 3 to 5 minutes if asystole persists. ( 2)

The protocol for administering an atropine (antimuscarinic) drip is to titrate according to heart rate, PR interval, blood pressure, and symptoms. The initial dose for adults can range from 0.5 to 1 mg for antisialagogue or antivagal effects, 2 to 3 mg for organophosphorus or muscarinic mushroom poisoning (repeated every 20 to 30 minutes), or 1 mg for bradyasystolic cardiac arrest (repeated every 3 to 5 minutes if asystole persists) 2. Key considerations include:

• Initial dose
• Titration
• Repeated doses as needed
• Monitoring of heart rate, PR interval, blood pressure, and symptoms.

From the Research

Atropine Administration Protocol

The protocol for administering an atropine (antimuscarinic) drip is not directly stated in the provided studies. However, some studies provide information on the dosage and administration of atropine in different contexts.

• The study 3 mentions the use of sublingual atropine, dosed at 0.4-0.8 mg, as an antisialogogue to facilitate dental procedures.
• The study 4 discusses the use of atropine and glycopyrrolate in reversing neuromuscular blockade, with atropine doses ranging from 10 to 30 microgram/kg.
• The study 5 examines the effects of intravenous atropine on gastric emptying, paracetamol absorption, salivary flow, and heart rate in young and elderly volunteers, with atropine doses of 300 and 600 micrograms.
• The study 6 investigates the maximum atropine dose without clinical signs or symptoms, finding that atropine 0.02% is the highest concentration that does not result in significant symptoms.
• The study 7 assesses the effect of atropine on parasympathetic control of respiratory sinus arrhythmia in two ethnic groups, using atropine doses ranging from 0.001 to 0.015 mg/kg.

Key Considerations

When administering an atropine drip, the following considerations should be taken into account:

• Dosage: The appropriate dosage of atropine will depend on the specific context and patient population, as well as the desired effect.
• Administration route: Atropine can be administered sublingually, intravenously, or via other routes, each with its own implications for dosing and effect.
• Patient monitoring: Patients receiving atropine should be closely monitored for signs of antimuscarinic toxicity, such as dry mouth, blurred vision, and tachycardia.
• Contraindications: Atropine may be contraindicated in certain patient populations, such as those with glaucoma or obstructive uropathy.