Treating Intraoperative Bradycardia in Non-cardiac Surgery Patients With Atropine at Heart Rates Below 60 Versus 30 Beats Per Minute and Norepinephrine Requirements

Launched by UNIVERSITY OF HAMBURG-EPPENDORF · Apr 9, 2025

Keywords

ClinConnect Summary

The RAPID trial is a study designed to find out how effective atropine is in treating a condition called intraoperative bradycardia, which means a slow heart rate during surgery. Specifically, the trial will compare giving atropine when the heart rate is below 60 beats per minute to giving it only when the heart rate drops below 30 beats per minute. Researchers want to see if this approach can reduce the need for norepinephrine, a medication used to raise blood pressure during surgery, in patients who are undergoing non-cardiac surgeries that last at least an hour.

To participate in this trial, patients must be at least 50 years old and scheduled for elective non-cardiac surgery with general anesthesia. They should also have at least two risk factors for developing kidney problems, such as being 65 or older, having high blood pressure, or diabetes. It’s important to note that some patients may not be eligible if they have certain health issues that make it unsafe for them to receive atropine. Participants in the trial will receive careful monitoring during their surgery to ensure their heart rate and blood pressure are managed safely.

Gender

ALL

Eligibility criteria

• Inclusion Criteria: Consenting patients ≥50 years scheduled for elective non-cardiac surgery with general anesthesia that is expected to last ≥60 minutes with at least two of the following risk criteria for developing acute kidney injury:
• • Age ≥65 years
• • American Society of Anesthesiologists physical status III or IV
• • Chronic arterial hypertension
• • Diabetes mellitus requiring medication
• • Intraabdominal surgery
• • Preoperative renal insufficiency (serum creatinine ≥1.2 mg/dL)
• Exclusion Criteria:
• • Patients with the following exclusion criteria: contraindication for atropine administration (e.g., myasthenia gravis, high-grade aortic stenosis, high-grade coronary artery disease, glaucoma, paralytic ileus, prostatic hypertrophy); renal replacement therapy within the previous 3 months; chronic kidney disease with an estimated glomerular filtration rate \<20 mL/min/1.73 m2; pregnancy.