Atropine’s adverse effects in anesthesia are primarily related to its antimuscarinic properties, which can lead to xerostomia (dry mouth), blurred vision, photophobia, tachycardia, and flushing. Hyperthermia and anhidrosis (lack of sweating) may also occur, particularly in elderly or heat-exposed patients. In rare cases, atropine can cause delirium, hallucinations, or coma, especially in high doses or patients with preexisting CNS disorders.
Due to its effects on cardiac demand, atropine should be used cautiously in patients with coronary artery disease, congestive heart failure, or tachyarrhythmias, as the increased heart rate and myocardial oxygen consumption may exacerbate these conditions. Additionally, caution is needed in patients with acute angle-closure glaucoma, benign prostatic hyperplasia, or urinary retention, as atropine can worsen these conditions.
Contraindications in Anesthesia
Atropine’s contraindications are primarily relative, meaning they should be considered in the context of the patient’s overall clinical condition. In unstable patients or those with life-threatening bradycardia or organophosphate poisoning, atropine should be administered regardless of potential contraindications. However, in more stable settings, clinicians should be cautious when using atropine in patients with myasthenia gravis, paralytic ileus, toxic megacolon, or obstructive uropathy, as it can worsen these conditions due to its antimuscarinic effects.
Monitoring and Toxicity
Atropine toxicity presents as an exaggeration of its antimuscarinic effects, with symptoms such as dilated pupils, warm, dry skin, tachycardia, tremors, ataxia, delirium, and coma. In severe cases, circulatory collapse and respiratory failure may occur. Treatment for atropine overdose includes physostigmine, a cholinesterase inhibitor that reverses both central and peripheral anticholinergic effects. Diazepam or short-acting barbiturates may be used to control convulsions or agitation.
