Glycopyrrolate as a Substitute for Atropine in Neostigmine Reversal of Muscle Relaxant Drugs

Advantages of Glycopyrrolate over Atropine during Reversal of Pancuronium Block

“…Our results show that the frequency of bradycardia is significantly less when pancuronium block is antagonized with glycopyrrolate-neostigmine instead of atropine-neostigmine. This difference was not found by some of the earlier investigators (RAMAMURTHY et al 1972, MIRAKHUR et al 1977, possibly due to a short observation period. OSTHEIMER (1 977) noticed bradycardia (HR less than 60 beats min-') in 7 % ofhis patients receiving atropine-neostigmine for reversal of the action of various relaxants, as compared with 1 % of those given glycopyrrolate-neostigmine.…”

“…In the present study, the number of patients showing nodal rhythm was somewhat smaller in the glycopyrrolate group than in the atropine group (2 vs 5) but the difference is not statistically significant. RAMAMURTHY et al (1972), studying patients anaesthetized with thiopental-N20halothane-tubocurarine, found one case of nodal rhythm in a group of 20 patients receiving glycopyrrolate-neostigmine for reversal of relaxant action, whereas three of 20 patients receiving atropine-neostigmine exhibited the same arrhythmia. Recent reviews (PRYS-ROBERTS 1981) emphasize the potential deleterious effects of nodal rhythm in patients suffering from hypertension and coronary artery heart disease, and we have demonstrated severe deterioration of circulation during an episode of nodal rhythm in an apparently healthy patient (HEINONEN et al 1981).…”

“…Glycopyrrolate is a quaternary-ammonium anticholinergic compound which has been suggested as a substitute for atropine during reversal of nondepolarizing neuromuscular block with neostigmine. When used with neostigmine, the antisialogogue action of glycopyrrolate is superior to that ofatropine (RAMAMURTHY et al 1972, MIRAKHUR et al 1977. The postanaesthetic responsiveness to verbal and painful stimuli is better with glycopyrrolate-neostigmine compared with atropine-neostigmine (BARAKA et al 1980); this difference has been attributed to the fact that atropine, asa tertiary amine, can cross the blood-brain barrier and hence may produce central anticholinergic effects.…”

“…The postanaesthetic responsiveness to verbal and painful stimuli is better with glycopyrrolate-neostigmine compared with atropine-neostigmine (BARAKA et al 1980); this difference has been attributed to the fact that atropine, asa tertiary amine, can cross the blood-brain barrier and hence may produce central anticholinergic effects. The initial increase in heart rate is significantly less after glycopyrrolate-neostigmine than after atropine-neostigmine (RAMAMURTHY et al 1972, OSTHEIMER 1977, MIRAKHUR et al 1977 and this difference is probably due to the slower onset of action of glycopyrrolate compared with atropine (MIRAKHUR et al 1981). Furthermore, there is some evidence that the decrease in heart rate may be less after glycopyrrolate-neostigmine than after atropineneostigmine (COZANITIS et al 1980).…”

Radioreceptor Assay for Pharmacokinetic Studies of Glycopyrrolate

“…Glycopyrrolate (pyrrolidinium 3-[(cyclopentylhydroxy/phenylacetyl)oxyl]-1,l -dimethyl bromide, glycopyrronium bromide) is a quaternary anticholinergic drug which was originally synthesized and used for the treatment of peptic ulceration about 30 years ago (Frank0 & Lunsford 1960). Since 1970, glycopyrrolate has been widely used in anaesthesiology as premedication and in the reversal of neuromuscular blockade as a substitute for atropine (Ramamurthy et al 1972;Mirakhur & Dundee 1983).…”