Metabolic and clinical responses to different types of premedication in children

The metabolic and clinical responses to intravenously administered atropine + meperidine (pethidine), glycopyrrolate + meperidine, diazepam and placeb o were examined in 76 healthy children. After atropine + meperidine and gly copyrrolate + meperidine administration, a significant antisialogogue effec t, tachycardia and elevation in systolic blood pressure were observed. Diaz epam decreased oxygen consumption (VO2) whereas atropine + meperidine incre ased both VO2 and energy expenditure (EE). The maximal effect of diazepam o n VO2 was found 10 min after drug administration (mean difference from base line -10.0%) and maximal effect of atropine + meperidine on VO2 and EE afte r 5 min (mean difference from baseline +6.0% and +3.3%, respectively). It i s concluded that intravenous administration of meperidine with atropine or glycopyrrolate is followed by profound anticholinergic effects and such com binations do not appear to be suitable for clinical purposes. Although stat istically significant, the alterations in VO2 and EE after diazepam and atr opine + meperidine premedication can be considered clinically insignificant because they were of short duration and the measured changes represented o nly a fraction of fluctuation seen in normal values.