| A Clinical Comparative Study of Glycopyrrolate and Atropine Mixed to Neostigmine . |
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Youn Woo Lee, Young Seok Lee, Kwang Won Park |
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Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea. |
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| Abstract |
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When antagonism of nondepolarising neuromuscular block is required ,atropine has been used as an anticholinergic drug to counteract the muscarinic actions of neostigmine. The timing of its administration with regard to that of neostigmine has been controversial. In most instances, the drugs were administered together, and the cause of the cardiac arrest was often attributed to the summation of the muscarinic action of neostigmine and the initial central vagal stimulation of atropine. Previous studies reported that slow simultaneous administration of atroplreneestigmine mixture was safe, even better when provided adequate oxygenation. Glycoppyrrolate is a potent, long-acting anticholinergic agent and recently it has been recommended as a suitable alternative to atropine. This study was undertaken to determine whether glycopyrrolate does offer any difference from atropine in heart rate, arrhythmia, blood pressure, body temperature and oropharyngeal secretion, on 54 gynecologic patients anesthetized with balanced technique, the neuromuscular block produced by pancuronium was reversed with (A) atropine-neostigmine(1.0mg: 2.0mg) or (B) glycopyrrolate-neostigmine(0.4mg:2.0mg) mixture. The results are as follows: 1) All of these combinations were effective reversing pancuronium-induced neuromuscular block as judged clinically by the adequate spontaneous respiration, head lift and grip strength test, 2) Mixture(B) was superior to (A) in producing less increased heart rate. 3) Mixture(B) was superior to (A) in producing lower incidence of bradycardia. 4) Mixture(B) was superior to (A) in producing more potent oropharyngeal drying effect. 5) Both groups showed similar effect on the cardiac rhythm. 6) Changes of systolic blood pressure any body temperature not significant in both groups. It is concluded that glycopyrrolate is an effective antimuscarinic agent and could be safely used as an alternative to atropine. |
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