Metabolic and clinical responses to different types of premedication in children

The metabolic and clinical responses to intravenously administered atropine + meperidine (pethidine), glycopyrrolate + meperidine, diazepam and placebo were examined in 76 healthy children. After atropine + meperidine and glycopyrrolate + meperidine administration, a significant antisialogogue effect, tachycardia and elevation in systolic blood pressure were observed. Diazepam decreased oxygen consumption (VO2) whereas atropine + meperidine increased both VO2 and energy expenditure (EE). The maximal effect of diazepam on VO2 was found 10 min after drug administration (mean difference from baseline -10.0%) and maximal effect of atropine + meperidine on VO2 and EE after 5 min (mean difference from baseline +6.0% and +3.3%, respectively). It is concluded that intravenous administration of meperidine with atropine or glycopyrrolate is followed by profound anticholinergic effects and such combinations do not appear to be suitable for clinical purposes. Although statistically significant, the alterations in VO2 and EE after diazepam and atropine + meperidine premedication can be considered clinically insignificant because they were of short duration and the measured changes represented only a fraction of fluctuation seen in normal values.