Comparison of the Effects of Atropine and Glycopyrrolate on various End-Organs<sup>1</sup>

Mirakhur, R. K.; Dundee, John W.

doi:10.1177/014107688007301008

Cited by 54 publications

(7 citation statements)

References 12 publications

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“…Anticholinergic drugs are increasingly being used in the premedication phase before small surgery 19 because of their capacity to reduce secretions, protect against vagal stimulation 20 , facilitate tracheal intubation, and provide a better visualization 21 . Glycopyrrolate is generally preferred to atropine because of its ability to inhibit saliva production and its more favorable safety profile (being characterized by a lower risk of cardiovascular or central nervous system adverse events) 22 , 23 . Moreover, premedication with glycopyrrolate may reduce sore throat after general endotracheal anesthesia, post-operative catheter-related bladder discomfort following general anesthesia, and the frequency and intensity of nausea, as well as the severity of hypotensive episodes during spinal anesthesia 24 – 28 .…”

Section: Discussionmentioning

confidence: 99%

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

Lee

Liu

Cheng

et al. 2020

Sci Rep

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Post-operative thirst is common and may cause intense patient discomfort. The aims of this retrospective study conducted in a high-volume post-anesthesia care unit (PACU) were as follows: (1) to examine the prevalence of moderate-to-severe post-operative thirst—defined as a numerical rating scale (NRS) score of 4 or higher, (2) to identify the main risk factors for moderate-to-severe post-operative thirst, and (3) to maximize the efficacy and safety of thirst management through a quality improvement program. During a 1-month quality improvement program conducted in August 2018, a total of 1211 adult patients admitted to our PACU were examined. Moderate-to-severe thirst was identified in 675 cases (55.8%). The use of glycopyrrolate during anesthesia was associated with moderate-to-severe thirst (71.7% versus 66.4%, respectively, p = 0.047; adjusted odds ratio: 1.46, p = 0.013). Following a safety assessment, ice cubes, room temperature water, or an oral moisturizer were offered to patients. A generalized estimating equation model revealed that ice cubes were the most effective means for thirst management—resulting in an estimated thirst intensity reduction of 0.93 NRS points at each 15-min interval assessment (p < 0.001)—followed by room temperature water (− 0.92/time-point, p < 0.001) and the oral moisturizer (− 0.60/time-point; p < 0.001). Patient satisfaction (rated from 1 [definitely dissatisfied] to 5 [very satisfied]) followed a similar pattern (ice cubes: 4.22 ± 0.58; room temperature water: 4.08 ± 0.55; oral moisturizer: 3.90 ± 0.55, p < 0.001). The use of glycopyrrolate—an anticholinergic agent that reduces salivary secretion—was the main independent risk factor for moderate-to-severe post-operative thirst. Our findings may provide clues towards an optimized management of thirst in the immediate post-operative period.

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Section: Discussionmentioning

confidence: 99%

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

Lee

Liu

Cheng

et al. 2020

Sci Rep

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“…Arbouw et al studied the efficacy of glycopyrrolate, an anti‐cholinergic that does not cross the blood–brain barrier in considerable amounts 33 . Twenty three participants took part in a crossover trial that compared 1 mg of glycopyrrolate taken three times daily against placebo.…”

Section: Resultsmentioning

confidence: 99%

“…18,23,26,29 Arbouw et al studied the efficacy of glycopyrrolate, an anticholinergic that does not cross the blood-brain barrier in considerable amounts. 33 Twenty three participants took part in a crossover trial that compared 1 mg of glycopyrrolate taken three times daily against placebo. A sialorrhoea scoring scale was used to assess efficacy and significant improvements were found in the group treated with glycopyrrolate.…”

Section: Reviewmentioning

confidence: 99%

Pharmacological Interventions for Sialorrhoea in People with Parkinson's Disease: A Systematic Review and Meta‐Analysis

Naeem

Reid

Bailey

et al. 2023

Movement Disord Clin Pract

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Background/objectives Background/objectives: Sialorrhoea is a common non motor complication experienced by people with Parkinson's disease (PD). Despite its prevalence there is conflicting evidence on how to effectively treat it. Our aim was to establish the efficacy and safety outcomes of pharmacological interventions used to treat sialorrhoea in people with idiopathic PD. Methods Methods: We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42016042470). We searched seven electronic databases from inception until July 2022. Quantitative synthesis was performed where data allowed using random effects models. ResultsResults: From 1374 records we included 13 studies (n = 405 participants). Studies were conducted in Europe, North America and China. There was marked heterogeneity in the interventions used, follow up times and outcome measures investigated. The main source of risk of bias identified was reporting bias. Five studies were included in the quantitative synthesis. Summary estimates showed administration of botulinum toxin significantly reduced saliva production, improved patient reported functional outcomes and was associated with an increase in adverse events. Conclusion Conclusion:Sialorrhoea in PD is an important condition, but current data does not allow for strong recommendations on optimal pharmacological treatments. There is significant heterogeneity in outcomes measures used to evaluate the burden of sialorrhoea with lack of consensus on what constitutes clinically meaningful change. More research is required to better understand the underlying mechanism and potential treatments of sialorrhoea in idiopathic PD.

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“…An older study demonstrated differences in end-organ effects between atropine and glycopyrrolate. Glycopyrrolate had a selective and prolonged inhibitory effect at salivary and sweat glands, with minimal cardiovascular, ocular, and CNS effects compared to atropine [ 40 ].…”

Section: Preventionmentioning

confidence: 99%

Vasovagal Reactions during Interventional Pain Management Procedures—A Review of Pathophysiology, Incidence, Risk Factors, Prevention, and Management

Malave

Vrooman

2022

Medical Sciences

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Vasovagal reactions are a benign but common outcome of interventional pain management procedures that can negatively impact patient care, including aborted procedures and fear of future procedures that would otherwise help the patient. Research has been done on the incidence, risk factors, and management of vasovagal reactions resulting from such procedures, but less is known about how to prevent these reactions from occurring. In this paper, we present a literature review of the pathophysiology, incidence, risk factors, prevention, and management of vasovagal reactions during interventional pain management procedures, with an emphasis on the relative lack of research and conflicting advice on preventive measures. We found that moderate sedation and anxiolytics have been used prophylactically to prevent vasovagal reactions, but their side-effect profiles prevent them from being used commonly. Less studied is the prophylactic administration of antimuscarinics and IV fluids, despite the potential benefit of these measures and relatively low side-effect profile. We explore these topics here and offer advice for future research to fill the gaps in our knowledge.

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Comparison of the Effects of Atropine and Glycopyrrolate on various End-Organs¹

Cited by 54 publications

References 12 publications

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

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

Pharmacological Interventions for Sialorrhoea in People with Parkinson's Disease: A Systematic Review and Meta‐Analysis

Vasovagal Reactions during Interventional Pain Management Procedures—A Review of Pathophysiology, Incidence, Risk Factors, Prevention, and Management

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Comparison of the Effects of Atropine and Glycopyrrolate on various End-Organs1

Cited by 54 publications

References 12 publications

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

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

Pharmacological Interventions for Sialorrhoea in People with Parkinson's Disease: A Systematic Review and Meta‐Analysis

Vasovagal Reactions during Interventional Pain Management Procedures—A Review of Pathophysiology, Incidence, Risk Factors, Prevention, and Management

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Comparison of the Effects of Atropine and Glycopyrrolate on various End-Organs¹