Bradycardia During Intra-Abdominal Surgery. Modification by Pre-Operative Anticholinergic Agents

Abstract

The aim of the present study was to examine, in a double-blind, randomised manner, the effects of glycopyrronium 0.005 mglkg, atropine 0.01 mgikg or a placebo (normal saIine) on the frequency of bradycardia in 92 patients scheduled for major abdominal or gynaecological surgery. All patients received fentanyl. halothane and vecuronium. The frequency of bradycardia in the group that received saline was 18%. No cases occurred in either anticholinergic group. Mean heart rates intra-operativeIy were not signiJicantly different between the atropine and glycopyrronium groups. It is suggested that the routine use of pre-operative anticholinergic agents should be considered when a similar anaesthetic technique is employed.

Reflex bradycardia during surgery

“…However, glycopyrrolate proved to be slightly superior, since it induced tachycardia of a smaller magnitude than atropine, which is particularly important in older patients where tachycardia can be as harmful as bradycardia. Coventry et al 36 came to similar conclusions in a comparable study comparing the two drugs.…”

Abdominal Wall Lift Versus Positive-Pressure Capnoperitoneum for Laparoscopic Cholecystectomy

“…One likely explanation for bradycardia after capnoperitoneum is a parasympathetic surge as a result of direct peritoneal and mesenteric stretch or secondary to reduced cardiac output. 19,20 The pulmonary adverse effects associated with general anesthesia are exaggerated by capnoperitoneum due to its splinting effect on the diaphragm, causing a significant rise in peak airway pressure, an increase in physiological dead space, and reduction in total lung compliance. The pulmonary function returned back to baseline in the postoperative period in keeping with previous reports.…”

Cardiovascular autonomic function in patients with hemodynamic instability at induction of capnoperitoneum: a case–control study

“…The precedence of parasympathetic over sympathetic effect on the heart rate at induction of PPCpn may be attributable to a more rapid response of the heart rate to parasympathetic stimulation than to sympathetic stimuli [13]. Vagally mediated bradycardia is not unique to conventional laparoscopic surgery, but also has been known to occur during abdominal manipulation in open surgery [4,6].…”