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PubMed1988

Effect of chronic atropine administration on the rat urinary bladder.

Micturition is accomplished via a coordinated contraction of the urinary bladder body mediated primarily by muscarinic receptor stimulation. Theoretically, bladder function may be modified by pharmacologically altering either the muscarinic receptor density and/or the magnitude of the response to receptor activation. In the central nervous system, autonomic receptor density can be modified by chronic administration of specific receptor agonists and antagonists. The chronic administration of receptor agonists induces a decrease in the specific receptor density whereas the chronic administration of antagonists induces an increase in the specific receptor density. Although these induced alterations in receptor density occur in the CNS, there have been few studies on peripheral tissue. For the current study, we have administered L-atropine chronically to rats (five mg./kg./day) using implanted osmotic pumps. Using direct radioligand binding techniques, the muscarinic receptor density of the rat brain (cortex) and urinary bladder were determined following six hours, 12 hours, one, two, four, seven, 11 and 14 days of atropine administration. In addition, we have also determined the effect of atropine administration on bladder weight and the response of isolated strips of the bladder to bethanechol, a specific muscarinic agonist. For both the brain and the bladder, the receptor density increased progressively and reached a maximum by seven days. At 14 days of atropine administration, the density of muscarinic receptors in rat brain increased significantly (p less than .05) from 2956 +/-74 fmoles/mg. protein to 3800 +/-170 fmoles/mg. protein. The muscarinic receptor density of the rat urinary bladder increased significantly from 115 +/-10 fmole/mg. protein to 165 +/-14 fmole/mg. protein. Although there was a 42% increase in bladder mass, the contractile response of isolated strips to bethanechol did not change significantly. This study demonstrates that the urinary bladder can respond to the chronic administration of atropine with a significant increase in the density of muscarinic receptors. The magnitude of the increase observed was slightly greater than the magnitude observed for muscarinic receptors isolated from the brain cortex.

Animals↗
PubMed1988

Retention of a spatial task after intraperitoneal, subcutaneous or intravenous injections of equal doses of atropine.

The retention of a well-learned spatial task was assessed in rats after equal doses of atropine sulfate (30 mg/kg) were administered by intraperitoneal, subcutaneous or intravenous injection. Atropine sulfate disrupted first choice accuracy and escape latency measures of spatial retention. Intravenous and intraperitoneal atropine sulfate produced significant impairments in choice accuracy. However, only intravenous atropine sulfate produced a significant impairment in escape latency. Atropine sulfate administered subcutaneously never produced a significant impairment in spatial retention compared to the intravenous saline control. One would predict from the present findings that a centrally active drug might produce a highly variable effect on a specific behavior as a function of the parenteral route of administration.

Animals↗
PubMed2001

Centrally injected atropine reduces hyperglycemia caused by 2-DG or immobilization stress in awake rats.

The physiological significance of central cholinergic neurons was investigated by verifying the effect of previous intracerebroventricular administration of atropine on the hyperglycemia induced by 2-deoxyglucose (2-DG) or by immobilization stress in unrestrained, nonanesthetized rats. Intravenous 2-DG induced a marked increase in plasma glucose that was not affected by atropine injected intracerebroventricularly 30 min before. However, the hyperglycemia induced by intracerebroventricular 2-DG was significantly reduced by previous intracerebroventricular injection of atropine. Immobilization induced a rapid increase of plasma glucose levels that was reduced by about 50% by intracerebroventricular injection of atropine. The increase in plasma lactate induced by intravenous 2-DG, or immobilization, was not significantly affected by previous intracerebroventricular injection of atropine. The data suggest that central cholinergic neurons participate in the complex neural events responsible for the hyperglycemic response to neurocytoglucopenia and to stressful situations.

Animals↗
PubMed2003

A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors.

OBJECTIVE: To assess whether the relative treatment effect of patching compared with atropine for moderate amblyopia varies according to patient age, cause of amblyopia or depth of amblyopia, and initial number of patching hours prescribed. DESIGN: Multicenter, randomized clinical trial. PARTICIPANTS: Four hundred nineteen children younger than 7 years of age with amblyopia in the range of 20/40 to 20/100. METHODS: Patients were assigned randomly to receive treatment with either patching or atropine and followed up for 6 months. PRIMARY OUTCOME MEASURE: Single-surrounded HOTV optotype visual acuity in the amblyopic eye after 6 months. RESULTS: Improvement in the amblyopic eye visual acuity was slightly greater in the patching group compared with the atropine group in all subgroups based on patient characteristics. The relative treatment effect did not vary with age (P = 0.84), cause of amblyopia (P = 0.68), or baseline amblyopic eye acuity (P = 0.59). Patients with acuity of 20/80 to 20/100 who were prescribed 10 or more hours a day of patching showed a more rapid improvement in acuity than did patients prescribed a lesser amount of patching (P = 0.01) or than did patients in the atropine group (P < 0.001), but by 6 months, the differences were not significant (P = 0.47 and 0.15, respectively). CONCLUSIONS: A beneficial effect of both patching and atropine is present throughout the age range of 3 to younger than 7 years old and the acuity range of 20/40 to 20/100. Patients with acuity of 20/80 to 20/100 improve faster when a greater number of hours of patching is prescribed, but by 6 months, the amount of improvement is not related to the number of hours of patching initially prescribed.

Age Factors↗
PubMed1991

A randomized comparison of atropine and metaproterenol inhalational therapies for refractory status asthmaticus.

STUDY OBJECTIVE: To compare the forced expiratory volume in one second (FEV1) response to inhaled anticholinergic with the response to beta-adrenergic solutions in adults with refractory status asthmaticus. DESIGN: After the decision was made to hospitalize, 40 patients were prospectively randomized in a double-blind trial to receive either atropine sulfate or metaproterenol by nebulizer. SETTING: A county teaching hospital emergency department. TYPE OF PARTICIPANTS: Adults requiring hospitalization for refractory status asthmaticus. INTERVENTIONS: Standard therapies for acute bronchospasm, followed by either 1.5 mg atropine or 15 mg metaproterenol by nebulizer. MEASUREMENTS AND MAIN RESULTS: The two groups were similar on entry into the study, including mean FEV1 measurements (0.70 L atropine/0.60 L metaproterenol, P greater than .05). Compared with baseline, The FEV1 improvement for the metaproterenol group was statistically significant (+ 0.18 L, P = .05; + 31%, P less than .05), whereas the improvement with atropine did not reach significance (+0.09 L or +10%, P greater than .05). Comparing the two groups, statistically significant differences favoring metaproterenol were found in the percent improvement in the FEV1 (+10% atropine/+31% metaproterenol, P less than .05) and in the percentage of patients experiencing at least a 15% decrease in their FEV1 below baseline (35% atropine/10% metaproterenol, P less than .05). No patient suffered adverse side effects. CONCLUSION: For the majority of adults with refractory status asthmaticus, an additional beta-adrenergic inhalation treatment results in greater FEV1 improvement than that resulting from the addition of an atropine inhalation.

Administration, Inhalation↗
PubMed1984

Atropine in asystole: human studies.

Current research supporting the use of atropine for asystole is limited. Reported in the literature are the cases of 26 patients who presented with a rhythm of asystole. Of these, only eight were clearly in refractory asystole after epinephrine and sodium bicarbonate, only seven were prehospital patients, and only two were delineated as being intubated. Despite such limited data, atropine has been advocated for asystole, and use of the drug is included in the recommendations of the American Heart Association. We undertook a retrospective review of our prehospital experience with refractory asystole for a four-year period from January 1979 to December 1982. All patients with trauma or poisoning and all pediatric arrests were excluded. All patients who received calcium chloride during resuscitation also were excluded. One hundred seventy patients presented in cardiorespiratory arrest with an initial rhythm of asystole. Of these, 84 remained in refractory asystole after receiving epinephrine and sodium bicarbonate. Forty-three patients in this group received atropine. The successful resuscitation rate in the atropine group was 14% (6/43), while in the control group it was 0% (0/41) (P less than .04). A successful resuscitation was defined as conveyance of a patient with a rhythm and a pulse to an emergency department. Patients were compared for age, sex, witnessing of arrest, cardiac history, and cardiac drugs. No other significant differences were noted between groups. No patient who received atropine for refractory asystole was discharged alive.

Arrhythmias, Cardiac↗
PubMed1996

Effects of beta-blockade and atropine on ischemic responses in left ventricular regions subtending coronary stenosis during dobutamine stress echocardiography.

OBJECTIVES: This study was designed to examine the effects of a beta-adrenergic blocking agent on the ischemic response to dobutamine stress and to determine the degree to which these effects can be abolished by the addition of atropine. BACKGROUND: Whether beta-blockade affects the sensitivity of dobutamine stress echocardiography for the diagnosis of coronary artery disease has been controversial. METHODS: In nine pigs, a left anterior descending coronary artery stenosis was created to reduce flow reserve (maximal/rest flow) to 1.1 to 1.9 without baseline regional wall motion abnormalities. This corresponded to a 50% to 90% diameter stenosis. Wall thickening was measured using epicardial echocardiography. Regional lactate production and coronary venous pH were monitored from an adjacent cardiac vein. A standard protocol of dobutamine stress echocardiography was first performed. After normalization of the ischemic abnormalities elicited with this infusion, esmolol was infused at 50 micrograms/kg body weight per min and the dobutamine test was repeated, with 1.0 mg of atropine added at the maximal dobutamine dose. RESULTS: Without esmolol, dobutamine stress induced myocardial ischemia with a reduction in regional wall thickening and lactate production in all nine pigs. Multiple regression analysis revealed that coronary flow per heartbeat (p < 0.01) and lactate production (p < 0.05) independently correlated with regional wall thickening during dobutamine stress. The beta-blocker significantly reduced heart rate and regional oxygen consumption and altered the relation between coronary flow per heartbeat and regional wall thickening (p < 0.05) during dobutamine stress. Esmolol prevented dobutamine-induced ischemia (lactate production and wall motion abnormalities) in seven of nine pigs. The addition of atropine induced lactate production and a reduction in wall thickening in five of seven pigs in which ischemia had been prevented by beta-blockade. However, lactate production was higher and regional venous pH was lower with the baseline dobutamine infusion than with that performed after esmolol with atropine added at the maximal dobutamine dose (p < 0.05). CONCLUSIONS: A correlation between regional wall thickening and coronary flow per heartbeat was demonstrated during baseline dobutamine stress. Beta-blockade shifted this relation so that dobutamine stress-induced myocardial ischemia was attenuated. The mechanisms by which beta-blockade prevents dobutamine-induced ischemia appeared to be mainly through decreases in heart rate and rate of rise in left ventricular pressure, improvement of regional coronary flow per heartbeat and attenuation of regional ischemic lactate production. Adding atropine in conventional doses enhanced the ability of dobutamine stress to induce myocardial ischemia but did not completely abolish the effects of beta-blockade on either the severity of dobutamine-induced wall thickening abnormalities or regional metabolic disturbances.

Adrenergic beta-Antagonists↗
PubMed1997

Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction. Echo Dobutamine International Cooperative (EDIC) Study.

OBJECTIVES: The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction. BACKGROUND: Dobutamine-atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 micrograms with atropine up to 1 mg) in one test. METHODS: Dobutamine-atropine stress echocardiography was performed 12 +/- 5 days (mean +/- SD) after a first uncomplicated acute myocardial infarction in 778 patients (677 men; mean age 58 +/- 10 years) with technically satisfactory rest echocardiographic study results. Patients were followed-up for 9 +/- 7 months. RESULTS: Dobutamine-atropine stress echocardiographic findings were positive for myocardial ischemia in 436 of patients (56%) and negative in 342 (44%). During follow-up, there were 14 cardiac-related deaths (1.8% of the total cohort), 24 (2.9%) nonfatal myocardial infarctions and 63 (8%) hospital readmissions for unstable angina. One hundred seventy-four patients (22%) underwent coronary revascularization (bypass surgery or coronary angioplasty). Spontaneous events occurred in 61 of 436 patients with positive and 40 of 342 patients with negative findings on dobutamine-atropine stress echocardiography (14% vs. 12%, p = 0.3). When only spontaneously occurring events were considered, the most important predictor was myocardial viability (chi-square 9.7). Using the Cox proportional hazards model, only the presence of myocardial viability (hazard ratio [HR] 2.0, p < 0.002) and age (HR 1.03, p < 0.001) were predictive of spontaneously occurring events. When only hard cardiac events were considered, age was the strongest predictor (chi-square 3.6, p = 0.056), followed by wall motion score index (WMSI) at peak dose (chi-square 3.3, p = 0.06) and remote ischemia (chi-square 2.25, p = 0.1). When cardiac death was considered, WMSI at peak dose was the best predictor (HR 9.2, p < 0.0001). CONCLUSIONS: During dobutamine stress, echocardiographic recognition of myocardial viability is more prognostically important than echocardiographic recognition of myocardial ischemia for predicting unstable angina, whereas WMSI at peak stress was the best predictor of cardiac-related death. Different events can be recognized with different efficiency by various stress echocardiographic variables.

Adult↗
PubMed2004

Winter cherry bugs feed on plant tropane alkaloids and de-epoxidize scopolamine to atropine.

The winter cherry bug colonizes the Duboisia leichhardtii tree, which is a rich source of scopolamine. It consumes the tropane alkaloids atropine and scopolamine. Quantitative analysis revealed that the ratio of scopolamine to atropine in the winter cherry bug (0.46) was far from that found in the leaves of the host plant (7.20). To elucidate whether the winter cherry bugs selectively excrete or decompose scopolamine, they were fed scopolamine and/or atropine together with sucrose. They took up scopolamine as well as atropine, and converted scopolamine into atropine.

Alkaloids↗
PubMed1999

Systemic bioavailability of ocularly applied 1% atropine eyedrops.

PURPOSE: To investigate the pharmacological basis of systemic effects of atropine eyedrops, we estimated the bioavailability of ophthalmic 1% atropine solution in healthy volunteers. METHODS: In a randomized crossover study we administered 0.3 mg atropine either intravenously or ocularly to six healthy volunteers. The plasma concentrations of the biologically active atropine enantiomer, 1-hyoscyamine, were determined using a muscarinic cholinoceptor binding assay. RESULTS: The mean area under the curve from zero to infinitum (AUC0-infinity) for 1-hyoscyamine was 1.862+/-0.580 microg/L x hr after intravenous, and 1.092+/-0.381 microl/L x hr after ocular administration (mean+/-sd, n=6), respectively. The mean bioavailability was 63.5+/-28.6% (mean+/-SD, n=6; min 19%, max 95%). Large interindividual differences characterized the absorption and elimination phases of 1-hyoscyamine kinetics. The terminal half-life (t1/2beta) of 1-hyoscyamine in plasma was not affected by the route of drug administration. CONCLUSION: The systemic bioavailability of 1-hyoscyamine was considerable and may explain the systemic anticholinergic side effects reported in association with the clinical use of atropine eyedrops.

Absorption↗
PubMed1990

Effects of systemic atropine sulfate administration on the frequency content of the cat sensorimotor EEG during sleep and waking.

Sensorimotor electroencephalogram (EEG) frequencies in cats were evaluated with power spectral analysis before and after 3 doses of atropine sulfate. All doses of atropine tested caused enhanced EEG slow waves (0-7 Hz) and spindles (8-15 Hz) during waking immobility, and postdrug frequency profiles during slow-wave sleep and waking immobility were identical. With 0.75 mg/kg atropine, movement (head movement, locomotion) resulted in EEG desynchronization and reduced power in all frequencies less than 24 Hz. After 1.5 or 3.0 mg/kg atropine, power in low frequencies remained elevated during movement, but power in spindle frequencies was significantly reduced compared with other states. During active REM sleep after 1.5 mg/kg atropine, power in spindle frequencies was significantly lower than that during quiet REM sleep. These results indicate that the sensorimotor cortical EEG in cats is under the control of multiple systems. At least 1 of these systems is active during movement, and its actions are resistant to muscarinic receptor blockade.

Animals↗
PubMed1999

Construction and analytical application of ion-selective piezoelectric sensor for atropine sulfate.

The method describes the use of a piezoelectric quartz crystal (PQC) as a substitute for ion-selective electrodes. The approach is feasible when the membrane materials are electrically non-conductive and membrane potential measurements are consequently not possible. An ion-selective piezoelectric sensor sensitive to atropine sulfate was constructed by coating a PVC membrane containing activant on one the side of a PQC. On the basis of selective adsorption of atropine ions across the modified film and the sensitive mass response of PQC, the method exhibits a sensitive, rapid response and is easy to operate without pretreatment of the sample. The logarithm of the frequency shift gave a linear relationship with the logarithm of atropine sulfate concentration in the 1.0 x 10(-8)-1.0 x 10(-3) M range with a detection limit of 5.0 x 10(-9) M at pH 7.0. Recoveries were from 98.7-102.2%. Two activants, atropine tetraphenylborate and atropine dipicrylaminate, were synthesized and investigated. Influencing factors were also examined and optimized. The results for real samples obtained by the proposed method agreed with those obtained by conventional methods.

Atropine↗
PubMed2000

The effects of atropine on dynamic compliance in healthy intubated adults.

In order to compare the effect of atropine and sodium chloride on the dynamic compliance of the respiratory system after tracheal intubation, we studied 20 patients allocated randomly into two groups to receive either: atropine after 5 min of steady state and sodium chloride after 10 min (group A) or in reverse order (group B) intravenously. The study was conducted in a randomized double-blinded manner. The patients were anaesthetized with thiopental 5 mg kg(-1) followed by thiopental 50 mg intravenously, as required. Intubation was facilitated by atracurium 0.5 mg kg(-1) intravenously and fentanyl 200 microg intravenously. During fixed volume ventilation (100 mL kg(-1), f=10), compliance and end-tidal carbon dioxide were measured every 10 s by a Datex AS/3-respiratory module connected to a portable IBM-pc. Five minutes was allowed to establish a steady state then either atropine or sodium chloride was administered according to the protocol. Respiratory dynamic compliance increased significantly after intravenous administration of atropine (P < 0.05). We conclude that atropine 1.0 mg given intravenously provides protection against an intubation-induced decline in respiratory dynamic compliance.

Adolescent↗
PubMed2002

Ultrasonographic evaluation of reticular motility in cows after administration of atropine, scopolamine and xylazine.

The goal of this study was to evaluate the effect of various dosages and routes of administration of atropine, scopolamine and xylazine on reticular motility in cows. Groups of five cows received atropine, scopolamine or xylazine at dosages varying from 0.01 to 0.20 mg/kg. The drugs were administered intramuscularly and intravenously; atropine was also given subcutaneously. A total of 17 trials, each using five cows, were carried out. Reticular motility was assessed for 3 min immediately prior to the administration of a drug and for 21 min after administration, and the latter period was divided into seven 3-min intervals. The motility was further assessed during 3-min periods every 10 min starting 28 min and ending 141 min after administration of a drug. During each 3-min interval, the number of reticular contractions or the occurrence of reticular atony was determined. Onset and duration of reticular atony were assessed. All three drugs inhibited reticular motility but onset varied with route of administration and dosage. As expected, the onset of reticular atony occurred most rapidly after intravenous administration of each drug, followed by intramuscular and subcutaneous administration. Reticular atony occurred 0-3.0 min after the intravenous administration of each drug and at all dosages except the lowest dosage of atropine. Atony lasted for 3-111 min. Reticular atony occurred 3-18 min and 9-15 min after intramuscular and subcutaneous administration, respectively. It lasted 32-108 min and 39-122 min for the intramuscular and subcutaneous routes, respectively. For each drug, higher dosages resulted in a more rapid onset and longer duration of reticular atony than did lower dosages. This study demonstrated that administration of atropine, scopolamine and xylazine results in reticular atony. Whether this has clinical relevance requires further investigation.

Adrenergic alpha-Agonists↗
PubMed2001

Effects of i.v. metoclopramide, atropine and their combination on gastric insufflation in children anaesthetized with sevoflurane and nitrous oxide.

METHODS: To determine effects of i.v. metoclopramide, atropine and their combination on the airway pressures at which gastric insufflation occurs in children, 45 healthy infants and children (ASA I) received an inhalational induction of anaesthesia with sevoflurane, N2O and O2. A blinded observer used a stethoscope to auscultate over the upper abdomen for any air entry. First, proximal airway pressure was slowly increased by closing the pop-off valve of the anaesthesia machine until gas was heard entering the stomach (pop-off point, control measurement). If the peak inspiratory pressure reached 40 cm H2O, the patient was to be excluded from the study. Then, all subjects randomly received i.v. atropine 0.01 mg.kg-1, metoclopramide 0.2 mg.kg-1, or atropine 0.01 mg.kg-1 plus metoclopramide 0.2 mg.kg-1 (n=15 each), and determination of the pop-off point was repeated 5 min later. The stomach was evacuated before each measurement. RESULTS: Atropine significantly decreased the pop-off point [from 21 +/- 3 to 19 +/- 2 cm H2O (mean +/- SD), P < 0.05], while metoclopramide significantly increased the pop-off point (from 20 +/- 3 to 26 +/- 6 cm H2O, P < 0.05). The combination of metoclopramide and atropine did not alter the pop-off point (from 20 +/- 2 to 19 +/- 5 cm H2O). CONCLUSION: Since metoclopramide exerts only mild effect on the pop-off point, cricoid pressure still remains the standard anaesthetic practice to prevent gastric insufflation in children. Prophylactic i.v. metoclopramide may be restricted to, and its clinical usefulness should be determined in, symptomatic patients with gastro-oesophageal reflux.

Anesthesia, General↗
PubMed2001

Administration of atropine in the setting of acute myocardial infarction: potentiation of the ischemic process?

Atropine has also been suggested to potentially worsen the ischemic situation in patients who are in the midst of acute coronary ischemia. We report the case of a female patient with ischemic chest pain and third degree atrioventricular block who developed acute myocardial infarction (AMI) immediately after atropine administration. The use of atropine in this instance remains a reasonable option and should be strongly considered-despite this apparent complication. Undoubtedly in some cases, acute ischemia is intensified by hypoperfusion attributable to vagally mediated bradyarrhythmia; atropine is the antidote for such situations. An awareness of this potential adverse reaction coupled with a prudent selection of candidates for atropine therapy will show the risk/benefit ratio in each individual patient and, therefore, guide the clinician.

Acute Disease↗
PubMed2000

Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study.

BACKGROUND: Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. METHODS AND RESULTS: Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis >/=50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration >/=160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). CONCLUSIONS: Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.

Adult↗
PubMed1982

[Side-effects of atropine: pharmacological, allergic, pseudo-allergic or toxic reactions?].

Between 1979 and 1981 31 children aged from one to 14 years who had been given atropine eye drops to measure refraction presented with the following side-effects: increased temperature (9/31), dry red skin (8/31), reddened eye (3/31) and periorbital dermatitis (2/31) after single (22/31) or repeated (9/31) administration of atropine. In the epicutaneous test with atropine eye drops 1% (readings after 24, 48 and 72 hours) not a single child showed an allergic or toxic reaction. The rarity of an allergy after administration of atropine drops is emphasized by the fact that periorbital dermatitis was observed in only two cases. Clinical experience shows that incipient allergy owing to the anatomical structure of the conjunctiva and eye lids first becomes apparent in the region of the eye, even if the epicutaneous test is not necessarily positive in the dorsum skin. In view of the necessity of administering atropine prior to emergency surgery it is advisable to carry out epicutaneous tests if side-effects have been observed in the eye, to make sure that the patient is not allergic to the drug.

Adolescent↗