DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED EVALUATION OF ATROPINE TO PREVENT VASOVAGAL REACTION DURING REMOVAL OF FEMORAL ARTERIAL SHEATHS

Study Objective. To evaluate the efficacy and safety of atropine in pr eventing vasovagal reactions (VVRs) during removal of femoral arterial sheaths after diagnostic left heart catheterization. Design. Prospect ive, double-blind, randomized, placebo-controlled study. Setting. Univ ersity-affiliated, 450-bed leaching hospital. Patients. One hundred si xty-five patients undergoing left heart catheterization. Interventions . Eighty-eight patients were assigned to receive atropine 0.5 mg intra venously and 77 received placebo 5 minutes before sheath removal. Meas urements and Main Results. The frequency of VVRs was significantly red uced in the atropine group compared with the placebo group, 2.3% and 1 0.4%, respectively (overall relative risk in the atropine group 0.22, 95% CI 0.12-0.41, p=0.03). Significant decreases in systolic (35.2 +/- 5.8 mm Hg, p<0.001) and diastolic blood pressures (12.6 +/- 12.6 mm H g, p=0.002) occurred in the 10 patients with VVRs compared with those without WR. No cardiac arrhythmias occurred after atropine administrat ion. Dry mouth was the only side effect reported with atropine (8/88, 9%). Conclusion. Atropine significantly reduced the frequency of VVRs associated with removal of femoral arterial sheaths after diagnostic l eft heart catheterization. The drug should be studied in a larger seri es of patients to assess its ability to decrease the morbidity and cos ts associated with WR.