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At least 667 records · Page 37Linked to original sources
PubMed1988

Antagonism of neuromuscular blockade. The cardiovascular effects in children of the combination of edrophonium and glycopyrronium.

Glycopyrronium 5 or 10 micrograms/kg was administered either simultaneously with, or 1 minute before, edrophonium 1 mg/kg in order to antagonise competitive neuromuscular blockade in 80 children. Both doses of glycopyrronium given before the edrophonium resulted in an initial significant (p less than 0.01) increase in heart rate. Heart rate decreased significantly (p less than 0.01) in all groups after the edrophonium was given, and only glycopyrronium 10 micrograms/kg administered before edrophonium prevented a substantial decrease below baseline. Initial heart rate responses to glycopyrronium or edrophonium are rapid, and measurements at intervals of 30 seconds may be necessary to record these changes.

Child↗
PubMed1988

Reversal of pancuronium. Neuromuscular and cardiovascular effects of a mixture of neostigmine and glycopyrronium.

Moderate to deep (67-99% single twitch depression) pancuronium-induced neuromuscular blockade was antagonised with neostigmine (30 micrograms/kg, 60 micrograms/kg, or 80 micrograms/kg) in combination with glycopyrronium. Twenty-seven patients were reversed from 91%-99% twitch depression. Recovery of the first twitch of a train-of-four to 95% of control twitch took at least 20 minutes with neostigmine 30 micrograms/kg. The higher doses were significantly faster (60 micrograms/kg p less than 0.05, 80 micrograms/kg p less than 0.01) and took 15.8 and 14.8 minutes respectively. Reversal to a train of four ratio of 0.75 was not consistently achieved in under 30 minutes with any dose of neostigmine. Nineteen patients were antagonised from a 67%-80% depression of first twitch and in all but two recovery to 95% of control took under 10 minutes. To achieve a train of four ratio of 0.75 took less than 12.5 minutes except in three patients, two of whom, both given neostigmine 30 micrograms/kg, took longer than 20 minutes. Neostigmine 60 micrograms/kg produced as rapid a degree of antagonism as 80 micrograms/kg. Heart rates after reversal decreased gradually in all groups, although the decrease was initially greater in the low dose neostigmine (30 micrograms/kg) group. A fixed 5:1 ratio of neostigmine and glycopyrronium will usually antagonise a moderate (70%-80%) pancuronium block to a train of four of greater than 75% within 12.5 minutes if at least 60 micrograms/kg of neostigmine is administered. More than 30 minutes may be required for reversal whatever the dose of neostigmine, for antagonism from greater than 90% twitch depression.

Adolescent↗
PubMed1989

A clinical study into the possible intrinsic bradycardic activity of vecuronium.

Forty female patients received a standardised anaesthetic technique with thiopentone sodium and enflurane. Half of the patients received, under double-blind conditions, either physiological saline or glycopyrronium before induction of anaesthesia; 10 minutes after induction of anaesthesia, all patients received vecuronium 0.1 mg/kg. A further 10 patients received neither glycopyrronium nor vecuronium. The results show that vecuronium per se does not produce a decrease in heart rate.

Adult↗
PubMed1990

Pharmacokinetics of glycopyrronium in parturients.

A sensitive radioreceptor assay was used to determine the pharmacokinetics of glycopyrronium 6 micrograms/kg after intramuscular (deltoid muscle) administration in eight Caesarean section patients. A fast absorption rate was found with a mean maximum plasma concentration (Cmax) of 6.3 (SD 1.5) ng/ml, a mean time to Cmax (Tmax) of 10.0 (3.8) minutes and the elimination half-life (t1) of 33.4 (1.92). The respective AUC0-8 h value was 5.61 (1.27) hours ng/ml. This dose produced a significant increase in the maternal heart rate after 10 minutes (p less than 0.05) and an antisialogogue effect after 30 minutes (p less than 0.05) of the drug injection. Almost half of drug (48.3%) was excreted into the urine within 3 hours. There were no measurable levels of glycopyrronium in the lumbar cerebrospinal fluid (CSF) after 60 minutes of drug injection. The concentrations of glycopyrronium in the umbilical venous (0.28 (0.25) ng/ml) and in the umbilical arterial (0.18 (0.11) ng/ml) plasma after 86 minutes of drug injection were low and clinically insignificant, as was the case in the amniotic fluid (0.15 (0.08) ng/ml).

Adult↗
PubMed1991

Cardiovascular changes at antagonism of atracurium. Effects of different doses of premixed neostigmine and glycopyrronium in a ratio of 5:1.

The cardiovascular changes in the 10 minutes following antagonism of an atracurium-induced block were studied in 32 patients. A 5:1 ratio combination of either 15, 35, 55 or 75 micrograms/kg neostigmine, with a corresponding dose of 3, 7, 11, or 15 micrograms/kg of glycopyrronium was used for antagonism. The least change in heart rate was with neostigmine 15 micrograms/kg with an increase of more than 15 beats/minute found in only one patient. Antagonism with 35, 55 and 75 micrograms/kg neostigmine mixture produced the greatest increase in heart rate at one minute and this was significantly different from the effect of the 15 micrograms/kg dose. Twenty out of 24 patients given the larger doses had heart rate increases in excess of 15 beats/minute and in nine patients this ranged from 30 to 52 beats/minute, representing increases of 46-80% above baseline values. Arterial pressure increases after antagonism were statistically significant in all four groups, with no between-group difference; these were clinically unimportant. When antagonising an atracurium-induced block with clinically useful doses of neostigmine, the standard 5 : 1 ratio combination with glycopyrronium will result in an initial tachycardia.

Anesthesia, General↗
PubMed1992

Changes in arterial blood pressure during traction of extra-ocular muscles. A study in rabbits.

A significant reflex fall in mean arterial blood pressure from baseline values was observed during extra-ocular muscle traction in rabbits. This effect could be abolished only by retrobulbar block (afferent pathway block) and not by vagotomy, intravenous atropine or glycopyrronium, suggesting that it is distinct from, and independent of, the oculocardiac reflex. We suggest that these reflex changes in blood pressure be known as the 'oculodepressor reflex'.

Animals↗
PubMed1992

The effect of pre-induction glycopyrronium on the haemodynamic response of elderly patients to anaesthesia with propofol.

This study investigated whether pretreatment with glycopyrronium can attenuate the hypotension caused by anaesthesia of the elderly with propofol. Twenty elderly patients (77.1 +/- 2.44 years, mean +/- SEM) of ASA physical status 2 or 3 scheduled for elective urological procedures were given glycopyrronium 0 (n = 10) or 5 micrograms.kg-1 (n = 10) in a randomised, double-blind manner, 5 min before induction of anaesthesia with propofol infused at 600 ml.h-1 (average induction dose 1.7 +/- 0.06 mg.kg-1, mean +/- SEM) followed by maintenance with a propofol infusion at 10 mg.kg-1.h-1. Although glycopyrronium significantly increased heart rate (p less than 0.01, ANOVA), the decrease in blood pressure 2 and 5 min after induction was similar in both groups. The study had a power of 80% to detect a 20 mmHg difference in systolic arterial pressure between treatment groups with p less than 0.05.

Aged↗
PubMed1978

Evaluation of the anticholinergic actions of glycopyrronium bromide.

1. Glycopyrronium was evaluated by intramuscular, intravenous and oral routes in six adult volunteers for its efficacy as an antisialogogue as also for its action on other aspects of cholinergic activity. 2. It was found to be an effective antisialogogue of long duration of action by all three routes. When given orally the effects were delayed in onset and persisted for too long. Intramuscular and intravenous routes were useful. The intramuscular absorption of the drug is rapid and consistent. 3. Sweat gland activity was affected in a similar fashion but less consistently and other parameters were mostly unaffected. 4. Glycopyrronium 0.2 mg intramuscularly was found to be the optimal dose. Larger doses produced subjective discomfort out of proportion to a further reduction in salivary secretion. 5. Intravenous administration causes no changes in cardiovascular stability.

Administration, Oral↗
PubMed1978

Effect of aluminium hydroxide and glycopyrrhonium on the absorption of ethambutol and alcohol in man.

1 The effect of aluminium hydroxide and/or of glycopyrrhonium on the absorption of a single oral 50 mg/kg dose of ethambutol (EMB) was investigated on thirteen tuberculous in-patients and on two groups of healthy volunteers with six subjects each. The EMB concentrations in serum and 10+h urine were measured by colorimetry. 2 In order to assess gastric emptying the healthy volunteers ingested ethanol, either 0.5 g/kg in 10% solution or 0.8 g/kg in 20% solution, simultaneously with the drug, and breath alcohol levels were measured repetitively. 3 Aluminium hydroxide significantly lowered the serum EMB levels of the patients during the first 4 h after the EMB intake. No consistent effect was found in the first student experiment, whereas in the second experiment aluminium hydroxide and glycopyrrhonium, alone or in combination, clearly retarded the EMB absorption. 4 Repeated breath alcohol analysis proved unsuitable to indicate the time course of gastric emptying in these circumstances.

Adult↗
PubMed1978

Effects on muscarinic receptors of various agents in reversal of neuro-muscular blockade: a study evaluating atropine, glycopyrron, neostigmine and pyridostigmine.

The effects were studied of various drug combinations, recommended for use in reversal of neuromuscular blockade, on heart rate and salivary secretions in 80 healthy patients anaesthetized with nitrous oxide-oxygen-halothane and relaxed with d-tubocurarine. The drug combinations were mixtures of atropine 1 mg--neostigmine 2.5 mg, atropine 1 mg--pyridostigmine 15 mg, glycopyrron 0.5 mg--neostigmine 2.5 mg, and glycopyrron 0.5 mg--pyridostigmine 15 mg, respectively. It was found that administration of the atropine-containing mixtures induced more pronounced initial increases and delayed decreases in heart rate than the mixtures containing glycopyrron. Pyridostigmine-containing mixtures elicited a somewhat more pronounced initial increase in heart rate than neostigmine-containing mixtures, but a less pronounced and delayed decrease in heart rate. Supraventricular arrhythmias occurred less frequently in the pyridostigmine groups than in the neostigmine groups. No such difference was found between the atropine and glycopyrron groups. Glycopyrron caused a more intense dryness of the mouth than atropine. A differential attitude towards the use of drugs for reversal of neuromuscular blockade, based on the cardiovascular state of the particular patient, might be recommendable.

Adolescent↗