Comparison Between Glycopyrrolate and Atropine in a Mixture With Neostigmine for Reversal of Neuromuscular Blockade

Abstract

Atropine and glycopyrrolate were compared in a mixture with neostigmine for reversal of neuromuscular blockade in patients undergoing open heart surgery. In patients not receiving beta-blocking drugs, glycopyrrolate was shown to possess advantages over atropine in terms of a lower initial increase in heart rate, better protection against the muscarinic effects of neostigmine, and smaller increases in rate-pressure product. The concomitant administration of beta-adrenergic blocking therapy significantly attenuated the effect of reversal on heart rate and the differences between atropine and glycopyrrolate were not significant. There was no difference in the incidence of arrhythmias between patients who received beta-blocking drugs and those who did not.

Prevalence, risk factors, and optimized management of moderate-to-severe thirst in the post-anesthesia care unit

“…However, one study reported that only 2% of patients who did not undergo premedication experienced excess secretion that required treatment 29 . Although the benefits and optimal dose of glycopyrrolate has been the subject of continuing debate [30][31][32] , this drug should be used judiciously because of its prolonged antisialagogue effect. The perception of thirst involves a number of components-including dry mouth, dry lips, thick tongue, thick saliva, dry throat, bad taste, and desire to drink water-which may have subtle distinctions 33 .…”

Pharmacokinetics and related pharmacodynamics of anticholinergic drugs

“…Anticholinergic drugs are often combined with neostigmine at the time of antagonism of the neuromuscular block. Several studies have demonstrated that glycopyrrolate is superior to atropine in this indication (8,64,65), because the faster onset of action of atropine results in initial tachycardia followed by a rapid fall in heart rate due to the onset of action of neostigmine, and postoperative bradycardia is more common because the duration of action of neostigmine is longer (66,67). Glycopyrrolate and neostigmine are both quaternary ammonium drugs, which have a parallel profile of pharmacodynamic actions; their onset of peak effects on heart rate is similar and so is the duration of action.…”

Different properties of the bradycardia produced by neostigmine and edrophonium in the cat

“…It has been claimed that glycopyrrolate has a smaller effect on basal heart rate than that of atropine, based on clinical studies which were complicated by previous administration of drugs with muscarinic effects (e.g., atropine, pancuronium and anticholinesterases), varying depths of anaesthesia, or unequal doses of glycopyrrolate and atropine. [28][29][30][31][32][33] Undoubtedly, the fact that glycopyrrolate is prepared as a 0.2 mg. m1-1 solution whereas atropine is 0.6 mg. ml -~, further contributes to the clinical impression that glycopyrrolate is less potent than atropine on basal heart rate. It is important to realise that, in clinical studies which were more specifically designed to compare the effects of glycopyrrolate and atropine on basal heart rate, it has been shown that glycopyrrolate is at least as potent (if not more so) as atropine.…”