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A short cut review was carried out to establish whether pre-treatment with atropine reduces the incidence of clinically significant bradycardia in children undergoing rapid sequence induction of anaesthesia in the Emergency Department. 112 papers were found using the reported searches, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that there is evidence that the routine use of atropine is does not reduce the incidence of bradycardia during RSI in paediatric patients.
Clinical scenario
An 8-month-old child presents to the emergency department in status epilepticus and is given so much benzodiazepines during treatment that he can no longer protect his airway. His vital signs are all stable and a non-rebreather mask is helping him to maintain his oxygen saturations. As you prepare to intubate him using RSI, you wonder if atropine is really necessary or helpful in preventing the bradycardia reported during endotracheal intubation.
Three-part question
In [paediatric patients undergoing rapid sequence intubation] does [pre-treatment with atropine] reduce the [incidence of clinically significant reflex bradycardia]?
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