Efficacy of Atropine to Blunt Unopposed Vagal Activity in Prevention of Hypotension in Parturients Undergoing Spinal Caesarean Section


  • Muhammad Salman Maqbool
  • Shumaila Ashfaq




Atropine, Co-load, hypotension, Obstetric anaesthesia, Subarachnoid Anaesthesia


Objective: To determine efficacy of prophylactic atropine to blunt un-opposed vagal activity in prevention of hypotension
associated with caesarean spinal block in first 15 minutes.
Study Design & Setting: Randomized controlled interventional study (purposive sampling method) done at Islam Teaching
Hospital, Sialkot from 03-3-2021 to 11-8-2021
Methodology: Chairman Ethics Review Board, Islam Medical College, Sialkot vide letter No.2021-04/A, dated 03-3-2021,
consented for study. G-power statistics v3.1.9.2, employing chi-square goodness of fit test value of 11.07, total sample was
144 bunched into two prophylactic treatment groups by using computer generated numbers (group-A, Inj. atropine 0.5mg
and group-B, Inj. Placebo (control) planned for elective caesarean spinal delivery. Primary study variable being hemodynamic
stability (pulse, blood pressure) in first 15 minutes after placing block. Independent-Samples Kruskal-Wallis Test used to
compare systolic blood pressures between groups for association. Chi- square hypothesis test, was done with P-value <0.05
considered as statistically significant. SPSS analysis was done with v.21
Results: In Atropine group-A, there was rather a 11% increase in mean heart rate at 15 minutes mark (statistically significant)
than the mean baseline value while in group-B(placebo)similar values parameter showed a 4.7% decline in mean heart rate
value. In group-A, mean systolic blood pressure value declined only by 12.2% at 15 minutes mark from baseline value
whereas in group-B, a decline of 13.2% was noted.
Conclusion: Prophylactic bolus of atropine against un-opposed vagal activity provided stable hemodynamic values in
cesarean spinal delivery


Sugo Y, Kubota M, Niwa H, Hirota K. Moderate rate

of implementation of spinal anesthesia for cesarean

section: does it improve neonatal well-being? A case–-

control study. Sci Rep 2021; 11:245. https://doi.org/10.


Kim WH, Hur M, Park SK, Yoo S, Lim T, Yoon HK,

Kim JT, Bahk JH. Comparison between general, spinal,

epidural, and combined spinal-epidural anesthesia for

cesarean delivery: a network meta-analysis. Int J Obstet

Anesth. 2019; 37:5-15. https://doi.org/ 10.1016/j.ijoa.


Khan ZH, Eftekhar N, Barrak RS. General versus Spinal

Anesthesia During Caesarean Section: A Narrative

Review. Arch Anesth Crit Care 2019; 5(1): 18-21. https://


Sklebar I, Bujas T, Habek D. Spinal anaesthesia-induced

hypotension in obstetrics: prevention and therapy. Acta

Clin Croat. 2019;58(1):90–95.

Rattenberry W, Hertling A, Erskine R. Spinal anaesthesia

for ambulatory surgery. BJA Educ.2019;19(10):321-28.

DOI: https://doi.org/10.1016/j.bjae.2019.06.001

Alegbeleye BJ. Sudden cardiac arrest under spinal

anesthesia in a mission hospital: a case report and review

of the literature. J Med Case Reports. 2018; 12:144.


Gelaw M, Haddis L, Abrar M, Aregawi A, Melese E.

Effects of prophylactic atropine in prevention of spinal

anesthesia induced hypotension and bradycardia in

geriatrics undergoing urological surgeries at a resource

limited setting in Central Ethiopia Int. J. Surg. Open

; prospective cohort study. 2020; 26:42- 48. https://doi.org/10.1016/j.ijso.2020.08.004

Akhtar FM, Pirzada A, Ashraf V. Prevention of hypotension in caesarean delivery under spinal anaesthesia; the

combination of modified supine wedged position, crystalloid cohydration and prophylactic atropine. PAFMJ

;58(4):429-36. https://pafmj.org /index.php/


Butterworth IV JF, Mackey DC, Wasnick JD. Morgan

& Mikhail Clinical Anesthesiology. 5th Edition. Appleton

and Lange 2013; 10: 189-98.

Sigdel S. Prophylactic use of IV atropine for prevention

of spinal anesthesia induced hypotension and bradycardia

in elderly: a randomized controlled trial.J Anesthesiol

Clin Sci. 2015; 4:5. https://doi.org/10.7243/2049-9752-


Arya S, Belwal S, Uniyal B, Tiwari B, Sharma P. Bezold

Jarisch Reflex- New Interest, Old Phenomenon, Am J

Intern Med. 2020;8(1):24-29. https://doi.org/ 10.11648/


Limongi JA, Lins RS. Cardiopulmonary Arrest in Spinal

Anesthesia. Rev Bras Anestesiol 2011;61(1):110-20.


Maqbool MS. Evaluation of Heart Rate Variability and

Baroreflex Sensitivity in Cesarean Spinal Delivery.

Med Forum 2018;29(3):78-82.

Warltier DC, Campagna JA, Carter C. Clinical Relevance

of the Bezold–Jarisch Reflex. Anesthesiology 2003;

:1250–1260. doi:10.1097/00000542-200305000-

Lim HH, Ho KM, Choi WY, Teoh GS, Chiu KY. The

use of intravenous atropine after a saline infusion in

the prevention of spinal anesthesia-induced hypotension

in elderly patients. Anesth Analg. 2000;91(5):1203-6.

doi: 10.1097/00000539-200011000-00029.

Ferre F, Martin C, Bosch L, Kurrek M, Lairez O,

Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020; 13:39-

doi: 10.2147/LRA.S240753

Lakshmi Vanaja N. Comparison of Atropine with Ephedrine in Prevention of Spinal Anesthesia Induced Hypotension in Elderly Age Group. Indian J Anesth Analg.

; 6:1973-77. DOI: http://dx.doi.org/10. 21088


Nze PU. Effect of pre-medication with atropine on the

blood pressure of parturient undergoing caesarian section

under spinal anaesthesia. Orient Journal of Medicine.

;15(1):1-4. DOI: 10.4314/ojm. v15i1.29037

19.Xu T, Zheng J, An XH, Xu ZF, Wang F. Norepinephrine intravenous prophylactic bolus versus rescue bolus

to prevent and treat maternal hypotension after combined

spinal and epidural anesthesia during cesarean delivery:

a sequential dose-finding study Ann Transl Med

;7(18): 451.DOI:org/10.21037/atm.2019.08.50

Aweke, Z., Mola, S., Solomon, F.E., Ayalew, N., Hailu,

S., Neme, D et al. Prophylactic efficacy of intravenous

atropine with crystalloid co-loading for hemodynamic

stability in parturient undergoing cesarean delivery at

Dilla University Referral Hospital. A randomized controlled trial. Int. J. Surg. Open.2021;30(2): 100321.DOI:


Nze PUN. Effect of pre-medication with atropine on

the blood pressure of parturient undergoing caesarian

section under spinal anaesthesia. Orient J Med.

;15(1):1-4. DOI: 10.4314/ojm. v15i1.29037

Luo XJ, Zheng M, Tian G, Zhong HY, Zou XJ, Jian

DL. Comparison of the treatment effects of methoxamine

and combining methoxamine with atropine infusion to

maintain blood pressure during spinal anesthesia for

cesarean delivery: a double blind randomized trial. Eur

Rev Med Pharmacol Sci. 2016;20(3):561-567. PMID:




How to Cite

Maqbool, M. S. ., & Ashfaq, S. . (2022). Efficacy of Atropine to Blunt Unopposed Vagal Activity in Prevention of Hypotension in Parturients Undergoing Spinal Caesarean Section. Journal of Bahria University Medical and Dental College, 12(03), 118–123. https://doi.org/10.51985/JBUMDC202201



Original Articles