ephedrine is more effective than atropine for the treatment of symptomatic bradycardia in elderly patients

Background]bradycardia may result in the exacerbation of myocardial dysfunction in elderly patients.[objectives]in this retrospective cohort study, ephedrine and atropine were compared for the treatment of symptomatic bradycardia.[methods]in this study, patients (above 65 years) with symptomatic bradycardia during skin tumor resection were evaluated. symptomatic bradycardia was defined as heart rate below 49 beats per minute and systolic blood pressure below 85 mmhg. according to the anesthesiologist's decision, 1 group of patients (atropine group) received atropine (0.5 mg) as the firstline drug, while the other group (ephedrine group) received ephedrine (10 mg) as the firstline drug to restore hemodynamic parameters. if the initial treatment had no effects on the management of the symptoms, ephedrine (10 mg) was administered to the patients in both groups. the number of patients, who received treatment with a single drug to normalize their hemodynamic parameters, was compared with those who required a second drug.[results]among 194 subjects with symptomatic bradycardia, 86 and 108 patients were allocated to the atropine and ephedrine groups, respectively. based on the findings, 35 patients in the atropine group required the second drug for bradycardia management; therefore, 51 patients were treated with only atropine (efficacy: 51/86, 59.30%). moreover, 21 patients in the ephedrine group required the second dose of ephedrine for the management of bradycardia; consequently, 87 patients were treated with only ephedrine (efficacy: 87/108, 80.55%). there was a statistically significant difference between the 2 groups (p = 0.001).[conclusions]ephedrine is more effective than atropine in the management of symptomatic bradycardia in elderly patients.