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PubMed1989

Preinduction atropine or glycopyrrolate and hemodynamic changes associated with induction and maintenance of anesthesia with propofol and alfentanil.

Total intravenous anesthesia by infusions of propofol and alfentanil may be associated with decreases in heart rate and blood pressure. The effects of two vagolytic agents on these hemodynamic changes were studied in 24 ASA physical status 1 patients undergoing body surface surgery. Patients were randomly allocated to receive atropine 10 micrograms/kg, glycopyrrolate, 5 micrograms/kg, or 0.9% sodium chloride, intravenously, 5 min before induction of anesthesia with loading doses of alfentanil, 50 micrograms/kg and propofol 1 mg/kg. Anesthesia was maintained with infusions of alfentanil 50 micrograms.kg-1.hr-1, and propofol 10 mg.kg-1.hr-1 for the first 10 min, 8 mg.kg-1.hr-1 for the next 10 min, and 6 mg.kg-1.hr-1 thereafter. Patients given glycopyrrolate before anesthesia had significantly higher arterial pressures than did patients receiving either atropine or saline, even though heart rates increased equally after glycopyrrolate and atropine.

Adult↗
PubMed1987

Intravenous administration of lenperone and glycopyrrolate followed by continuous infusion of sufentanil in dogs: cardiovascular effects.

Cardiopulmonary effects of IV administration of lenperone (0.44 mg/kg) and glycopyrrolate (0.11 mg/kg) were determined in 6 healthy adult (2 to 5 years) Pointers during controlled ventilation with oxygen. Sufentanil was then administered as a loading dose (5 micrograms/kg, IV) and continually infused (0.1 microgram/kg/min) for 120 minutes. Lenperone-glycopyrrolate did not significantly affect heart rate, but induced a significant decrease in systemic vascular resistance, rate-pressure product, and mean arterial pressure, and significantly increased cardiac index. Administration of sufentanil did not significantly affect mean arterial pressure. Heart rate and rate-pressure product were significantly decreased during sufentanil infusion. Systemic vascular resistance gradually increased during the 2-hour sufentanil infusion and was not significantly different from base-line values at end of study. Cardiac index was not significantly different from baseline values during sufentanil infusion, except at 90 and 120 minutes, when it was significantly less. As administered in the present study, lenperone, glycopyrrolate, and sufentanil are safe and efficacious in adult dogs.

Animals↗
PubMed1988

[Effect of glycopyrrolate and atropine on the behavior of heart rate and pH value of gastric juice during microlaryngoscopies].

In a prospective study a total of 51 patients were given either a premedication with atropine (10 micrograms/kg) (n = 17), with glyopyrrolate (5 micrograms/kg) (n = 15) or no anticholinergic premedication (n = 19). In the group of patients premedicated with glycopyrrolate the pH levels of the gastric juice were more often above 2.50 than in the group without anticholinergic premedication (p less than 0.05). During the microlaryngoscopic interventions there was a trend to fewer A-node rhythms or bradycardias in the group premedicated with glycopyrrolate than in the other groups. Reduction of salivary gland secretion by anticholinergics made intervention easier. Glycopyrrolate has advantages over atropine as far as the induction of anaesthesia for microlaryngoscopic interventions is concerned.

Aged↗
PubMed1987

Atropine methylbromide and glycopyrrolate. A comparative study during reversal of neuromuscular block.

Two quaternary anticholinergics, atropine methylbromide (methylatropine bromide, MAB) and glycopyrrolate (ROBINUL) were compared as adjuncts to neostigmine for the reversal of residual nondepolarising neuromuscular block. MAB 0.75 mg in combination with neostigmine 2 mg produced a marked initial rise in heart rate. This was significantly greater than that produced by the administration of glycopyrrolate 0.4 mg with neostigmine. The antisialogogue effects of the two anticholinergics were identical and the central nervous system status of the patients was similar. It is concluded that, with the doses used in this study, glycopyrrolate is a superior alternative to MAB and is the drug of choice if a quaternary ammonium anticholinergic is required.

Adolescent↗
PubMed1986

Atropine and glycopyrrolate as ECT preanesthesia.

Twenty-four patients receiving ECT were systematically studied to compare the effects of two dosages of atropine and two dosages of glycopyrrolate as preanesthetic agents. Glycopyrrolate resulted in more cardiac arrhythmias, nausea and vomiting, and episodes of bradycardia than atropine (p = .4). More patients receiving atropine showed post-ECT confusion, but the clinical impact of this was minimal. Atropine appears to be preferable to glycopyrrolate for use in ECT preanesthesia.

Adolescent↗
PubMed1979

Atropine versus glycopyrrolate. A study using repeated doses of suxamethonium in man.

Intermittent doses of suxamethonium have been known to result in bradycardia changes in cardiac rhythm. In order to assess the efficacy of a newer quaternary ammonium antimuscarinic, glycopyrrolate, on the cardia effects of intermittent suxamethonium, 28 patients received this drug intravenously just before induction of anesthesia. For comparison, 28 other patients were given atropine. In the atropine series, three patients developed bradycardia while none of those of the glycopyrrolate series did so. In addition, more patients had cardiac arrhythmias in the atropine group. Although no statistically significant differences were seen, clinically, glycopyrrolate seems to afford better protection against the cardiac changes resulting from intermittently administered suxamethonium.

Adult↗
PubMed1983

Electroencephalographic changes and arousal time after atropine or glycopyrrolate.

The Anaesthesia and Brain activity Monitor was used to determine if any electroencephalographic variation becomes evident following the administration to patients of either atropine sulphate or glycopyrrolate when given with neostigmine to reverse a non-depolarising neuromuscular blockade. The apparatus was also used to study possible earlier arousal times by electroencephalography and electromyography in those patients who had received glycopyrrolate with neostigmine compared with those who had atropine as an anticholinergic. The apparatus was not sensitive enough to detect changes resulting from atropine injection but clearly demonstrated earlier arousal times by electromyography in patients who had received glycopyrrolate.

Adult↗
PubMed1995

A comparison of propofol and isoflurane anaesthesia: the need for ephedrine and glycopyrrolate.

Sixty patients, ASA I-III, presenting for elective colonic surgery were studied to assess the stability of blood pressure and heart rate during anaesthesia with three equally potent anaesthetic techniques. Patients in group I (n = 20) received thiopentone induction, isoflurane and nitrous oxide; patients in group II (n = 20) received total intravenous anaesthesia with propofol; and patients in group III (n = 20) received intravenous propofol supplemented with nitrous oxide. Fentanyl and vecuronium were used in all three groups. The depth of anaesthesia was judged on clinical signs of adequate anaesthesia. Episodes of bradycardia (heart rate < 50 beats min-1), tachycardia (heart rate > 90 beats min-1), hypotension (mean arterial pressure > or = 30% below pre-operative blood pressure) or hypertension (mean arterial pressure > 30%, or systolic blood pressure > 15 mmHg, above pre-operative value) were recorded when lasting > 5 min. Any use of ephedrine or glycopyrrolate given to correct hypotension or bradycardia was documented: In group II, significantly more patients were given ephedrine (P < 0.01) to treat hypotension. The drug was administered after intubation but before skin incision in the majority of cases (9/11). Glycopyrrolate was given to significantly more patients in group III (P < 0.025) to treat bradycardia, and in 21 of a total of 34 patients given glycopyrrolate it was administered before surgery. With the use of these additional drugs, there were no differences in the number of patients with 5 min episodes of hypotension, hypertension, tachycardia or bradycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Use of glycopyrrolate to treat intraoperative penile erection. Case report and review of the literature.

BACKGROUND AND OBJECTIVES: Penile erections following the initiation of either axial regional or general anesthesia is rare; however, when it occurs in patients undergoing urologic procedures it may delay, or even cancel, the planned surgery. The purpose of this case report and review is to enhance anesthesiologists' understanding of this phenomenon so that they may better formulate a logical treatment scheme in such an event. METHODS: We present a case of intraoperative erection after the initiation of continuous spinal anesthesia that was treated with intravenous glycopyrrolate. From the literature, 72 references were reviewed. RESULTS: Glycopyrrolate successfully treated intraoperative penile erection. The physiology and pharmacology of erection are reviewed, and pharmacologic treatment options and surgical treatments are reviewed. CONCLUSIONS: In patients with coronary artery disease, or in situations where cardiovascular stability is desired, glycopyrrolate is an effective means of relieving intraoperative penile erections. Other pharmacologic interventions, based on the physiology of erections, are presented. Nitric oxide, a potent smooth muscle relaxant, has been shown to be involved in the initiation and maintenance of erections; future research involving specific inhibitors of this chemical is indicated for the possible treatment of intraoperative penile erections.

Anesthesia, Epidural↗
PubMed1996

Treatment of diabetic gustatory sweating with topical glycopyrrolate cream.

A 42-year-old insulin-dependent diabetic man presented with severe bilateral gustatory sweating associated with a deterioration in his glycaemic control. Conventional oral antimuscarinic medication was contraindicated because of his cardiac insufficiency. Topical 0.5% glycopyrrolate cream was tried and applied on alternate days to his face, which resulted in the complete cessation of his gustatory sweating without side-effects. Topical glycopyrrolate cream is an effective treatment of diabetic gustatory sweating without the adverse effects commonly found with oral anti-muscarinic medication.

Administration, Topical↗
PubMed1978

The effect of glycopyrrolate (Robinul) on the lower oesophageal sphincter.

Regurgitation and inhalation of acid gastric content, with resultant chemical pneumonitis, remains a common cause of death during anaesthesia. The effects of intravenous glycopyrrolate 0.3 mg on the lower oesophageal sphincter tone was studied in normal human subjects. Glycopyrrolate decreased lower oesophageal sphincter pressure by 0.88 kPa (p less than 0.005). This finding is of clinical importance in the pre-operative preparation of patients presenting for emergency surgery. A drug which decreases lower oesophageal sphincter tone would presumably increase the hazard of gastro-oesophageal reflux and pulmonary aspiration of acid gastric content.

Adolescent↗
PubMed1984

Effect of halogenated anaesthetics on heart rate changes during reversal of neuromuscular block with glycopyrrolate and neostigmine.

The effect of halothane and enflurane on changes in heart rate during reversal of neuromuscular blockade was compared in 48 patients. Premedication and anaesthetic technique was standardized. Either halothane or enflurane was used as the primary anaesthetic. Neuromuscular block was reversed by injection of glycopyrrolate and neostigmine, given either separately or simultaneously. Heart rate changes were significantly different between the halothane and enflurane subgroups. Patients anaesthetized with enflurane showed less fluctuations in heart rate. Simultaneous injection of glycopyrrolate and neostigmine minimized the tachycardia in the halothane subgroups only.

Adult↗
PubMed1979

Glycopyrrolate and cardiac dysrhythmias in geriatric patients after reversal of neuromuscular blockade.

The increase in cardiac muscarinic activity following injection of anticholinesterases can be minimized by the long-acting anticholinergic drug glycopyrrolate. In a series of 50 patients 65 years of age or older who had received glycopyrrolate (0.88 +/- 0.15 mg) mixed with neostigmine (4.40 +/- 0.66 mg) or pyridostigmine (17.46 +/- 2.92 mg) to antagonize neuromuscular blockade, the incidence of new postoperative cardiac dysrhythmias was 16 per cent. All dysrhythmias occurred in patients with pre-existing cardiovascular disease. There was no statistically significant relationship between the incidence of cardiac dysrhythmias and the choice of anaesthetic technique or anticholinesterase drug.

Aged↗
PubMed1988

Twelve-hour bronchodilation in asthma with a single aerosol dose of the anticholinergic compound glycopyrrolate.

Anticholinergic aerosols provide effective bronchodilation in some patients with obstructive lung disease. Glycopyrrolate is a quaternary ammonium anticholinergic compound that is poorly absorbed from mucus membranes, thus reducing anticholinergic side effects. In 20 adult patients with asthma, we evaluated bronchodilation to a single administration of metered-dose glycopyrrolate aerosol (GA) to ascertain its onset and duration of action along with evaluation of safety. In this randomized, double-blind, placebo-controlled, single-dose, crossover trial, bronchodilation was evaluated on five separate occasions to either placebo or a GA dose of 80, 240, 480, or 960 micrograms. Baseline spirometry for each patient on each visit was similar (mean FEV1 +/- SD of 62.2 +/- 13.6% predicted). After aerosol dosing, spirometry was measured at 30 minutes and then at hourly intervals up to 12 hours. Compared to placebo, metered-dose aerosols of 240, 480 and 960 micrograms elicited significantly greater bronchodilation at each test time. Furthermore, significant bronchodilation was noted within 30 minutes of dosing and was sustained for at least 12 hours. Bronchodilation with the 480 and 960 micrograms dose was equal, and both were greater than 240 micrograms. A subset of four asthma patients with baseline FEV1 values less than 50% predicted did not have a bronchodilating response with GA. No notable side effects occurred. Thus, a single aerosol dose of GA provides clinically significant, safe 12-hour bronchodilation in patients with asthma without severe airway obstruction (i.e., FEV1 greater than 50% predicted).

Adult↗
PubMed1987

Intravenous use of glycopyrrolate in acute respiratory distress due to bronchospastic pulmonary disease.

A patient with acute respiratory distress secondary to emphysema and reactive airway disease had inadequate tidal volumes with and without endotracheal intubation. Because of the patient's failure to respond to maximal standard bronchodilator therapy and the physical inability to ventilate the patient by manual positive pressure, he received IV glycopyrrolate (0.2 mg) approximately 50 minutes after admission to the ED. The patient's condition immediately improved, as evidenced by the ability to manually ventilate the patient; he developed increased tidal volumes; and he began responding to inhalation therapy. This is the first reported case of IV glycopyrrolate administration for chronic obstructive pulmonary disease or asthma in the literature and demonstrates an instance in which inhalation therapy was ineffective due to low tidal volumes.

Acute Disease↗
PubMed1979

Glycopyrrolate as a premedicant: comparison with atropine.

A double-blind comparison of glycopyrrolate with atropine as the anticholinergic component of premedication was made in 200 patients undergoing minor or intermediate surgical procedures. Glycopyrrolate was associated with a smaller increase in heart rate, but there was no difference between the drugs in respect of cardiac arrhythmia, change in arterial pressure, control of secretions in the upper respiratory tract, frequency of nausea and vomiting after operation or subjective well-being of the patients.

Adolescent↗
PubMed1980

Evaluation of glycopyrrolate and atropine as adjuncts to reversal of non-depolarizing neuromuscular blocking agents in a "true-to-life" situation.

Glycopyrrolate, a quaternary ammonium anticholinergic compound, and atropine were evaluated in combination with neostigmine for antagonism of non-depolarizing neuromuscular block. A total of 641 patients were investigated in a "true-to-life" situation. The patients receiving glycopyrrolate with neostigmine had smaller changes in heart rate than those who received atropine. This was particularly apparent in patients with cardiovascular disease.

Atropine↗