Atropine premedication and respiratory complications.

Sir,—Jones and Drummond (1981) have shown that premedication with atropine does not influence the frequency of postoperative respiratory complications. However, they do not nuke a recommendation for routine use, or otherwise, of atropine in premedicatioa. Studies on the effects of atropine administration on ciliary activity have shown conflicting results. Experimental studies in dogs have not shown any inhibition of mucociliary transport (Chopra, 1978; King, Cohen and Viires, 1979), but in anaesthetized patients, atropine has been shown to decrease it (Annis, Landa and Lichtiger, 1976). One could deduce from the report of Jones and Drummond (1981) that atropine was not helpful in the reduction of chest complications after operation. In a survey of anaesthetists (Mirakhur et al., 1978) it was found that one-third of anaesthetists did not use anticholinergic drugs routinely in premedication. A principal reason was that they felt that atropine made the secretions viscid and perhaps difficult to expectorate. The omission of routine administration of anticholinergic premedication does not seem to influence the course of anaesthesia in any adverse manner (Kessell, 1974; Leighton and Sanders, 1976; Mirakhur and Dundee, 1979; Mirakhur, Dundee and Connolly, 1979). If atropine does not prevent respiratory complications, why use it routinely in premedication in view of the discomfort of a dry mouth and the pain of an i jn. injection?