Atropine test and circulatory arrest in the fossa posterior assessed by transcranial Doppler.
OBJECTIVE: To evaluate whether a negative atropine test (i.e., increase in heart rate of less than 3% after intravenous administration of 3 mg atropine) correctly predicts circulatory arrest in the fossa posterior during craniocaudal herniation in patients with primary supratentorial lesions. MATERIAL AND METHODS: Prospective, observational clinical study. SETTING: Two surgical intensive care units in a university hospital. PATIENTS: In 45 consecutive patients with suspected brain death, an atropine test (AT) and a transcranial Doppler sonography were performed simultaneously and, if necessary, repeatedly. MEASUREMENTS AND RESULTS: Forty-four patients fulfilled the typical criteria of a supratentorial and infratentorial circulatory arrest as the atropine test became negative. In one patient, who had undergone a decompressive craniectomy for uncontrollable intracranial pressure 4 h prior to the AT testing, we found a negative AT in the presence of an antegrade supratentorial and infratentorial flow. CONCLUSION: A negative atropine test indicates a circulatory arrest in the fossa posterior in patients with primary supratentorial lesions and craniocaudal herniation. In patients with brain-stem lesions, however, a negative atropine test does not unequivocally indicate a circulatory arrest.[1]References
- Atropine test and circulatory arrest in the fossa posterior assessed by transcranial Doppler. Hüttemann, E., Schelenz, C., Sakka, S.G., Reinhart, K. Intensive care medicine. (2000) [Pubmed]
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