Anaesthesiologists and the Perils of Misidentification: Atropine vs. Dexmedetomidine in the Preoperative Period

In the preoperative period, anaesthesiologists play a crucial role in patient care, particularly in medication administration. The distinction between medications can be pivotal, especially when considering atropine and dexmedetomidine—two medications that, despite looking similar and being of the same size, have vastly different effects, particularly in the context of bradycardia.

Atropine is commonly used to increase heart rate in cases of severe bradycardia. Its mechanism of action involves blocking muscarinic acetylcholine receptors, thereby countering the inhibitory effects of the parasympathetic nervous system on the heart. In contrast, dexmedetomidine, a sedative used in the preoperative period, acts as a selective agonist of α2-adrenergic receptors, leading to bradycardia and decreased sympathetic outflow.

The inadvertent administration of dexmedetomidine instead of atropine can have serious consequences, especially in a patient already experiencing bradycardia. The sudden decrease in heart rate caused by dexmedetomidine can lead to hemodynamic instability, compromising the safety of the patient.

The similarity in appearance of these medications in the preoperative period underscores the importance of meticulous attention to detail in their administration. Anaesthesiologists must be acutely aware of the risks and take all necessary precautions to ensure the correct medication is administered.

Proper labeling, verification by multiple healthcare providers, and clear communication are essential in preventing medication errors in the preoperative period. The gravity of the situation cannot be overstated; accurate identification and administration of medications are critical in ensuring patient safety. Anaesthesiologists must remain vigilant and informed to mitigate the risks associated with medication administration in the preoperative period.


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