Atropine treatment of vagal bradycardia — FRCA Primary MCQ

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EasyPharmacologyAtropine treatment of vagal bradycardiaFRCA Primary

During traction on the extraocular muscles in a child, heart rate falls abruptly from 110 to 45/min and blood pressure begins to fall. Which drug is most appropriate?

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Correct answer: E — Atropine

The oculocardiac reflex is a vagally mediated bradycardia, and atropine antagonises muscarinic acetylcholine receptors to increase heart rate. Phenylephrine may raise blood pressure but can worsen reflex bradycardia. Esmolol would aggravate the bradycardia, while ondansetron and tranexamic acid do not treat the mechanism. Immediate communication with the surgeon to stop traction is also essential.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; paediatric anaesthesia texts