Glycopyrrolate as a substitute for atropine in neostigmine reversal of muscle relaxant drugs

Ramamurthy, Somayaji; Shaker, M. H.; Winnie, Alon P.

doi:10.1007/bf03005964

Cited by 49 publications

(5 citation statements)

References 18 publications

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“…It was found that a safe and effective ratio of the two drugs was glycopyrrolate 0.2 mg : neostigmine 1 mg. This conclusion had been reached previously by Ramamurthy, Shaker and Winnie (1972) while examining the time sequence and dosage of glycopyrrolate with respect to neostigmine. Previous studies (Baraka, 1968b;Ovassapian, 1969;Rosner, Kepes and Foldes, 1971) have shown that atropine and neostigmine are better administered together.…”

Section: Resultssupporting

confidence: 52%

“…We did not observe an initial tachycardia with the use of the glycopyrrolate-neostigmine mixture although the heart rate did decrease slightly over the period of antagonism. However, a slight initial tachycardia has been reported by others (Klingenmaier et al, 1972;Ramamurthy, Shaker and Winnie, 1972) and Wong and others (1974) reported significant increases in heart rate in children undergoing cardiac surgery following the use of glycopyrrolate-neostigmine mixtures. The increases were less than those noted with the atropine-neostigmine mixture but the greatest tachycardia following glycopyrrolate (in the mixture) occured at 2 min after injection as compared with the peak at 1 min following atropine.…”

Section: Resultsmentioning

confidence: 87%

“…long-acting anticholinergic agent and more recently it has been recommended as a suitable alternative to atropine (Klingenmaier et al, 1972;Ramamurthy, Shaker and Winnie, 1972;Oduro, 1975). Its main advantages are that it has an onset of action similar to that of neostigmine and, being a quaternary compound, it does not cross the blood-brain barrier.…”

mentioning

confidence: 99%

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Glycopyrrolate—neostigmine Mixture for Antagonism of Neuromuscular Block: Comparison With Atropine—neostigmine Mixture

Mirakhur¹,

Dundee²,

Clarke³

1977

British Journal of Anaesthesia

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Glycopyrrolate, a new anticholinergic agent, was evaluated and compared with atropine. Glycopyrrolate 0.2 mg to neostigmine 1.0 mg was found to be safe and effective. The heart rates remained more stable with glycopyrrolate, and the frequency of arrhythmia, which was both transient and of no consequence, was similar in the two groups. The antisialogogue action of glycopyrrolate was superior to that of atropine.

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Section: Resultssupporting

confidence: 52%

Section: Resultsmentioning

confidence: 87%

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Glycopyrrolate—neostigmine Mixture for Antagonism of Neuromuscular Block: Comparison With Atropine—neostigmine Mixture

Mirakhur¹,

Dundee²,

Clarke³

1977

British Journal of Anaesthesia

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“…However, it is possible that doses in excess of those used here may produce tachycardia, but then the dryness would be very intense and extremely unpleasant. Though studies of the heart rate with doses of glycopyrrolate up to 0.2 mg intravenously showed no significant rise in heart rate (Wyant & Kao 1974, Mirakhur 1979, doses of 0.5 mg administered in a mixture with 2.5 mg neostigmine have effectively prevented bradycardia induced by neostigmine (Ramamurthy et al 1972, Ostheimer 1977, Mirakhur et al 1977). However, we do not recommend the routine use of glycopyrrolate as a premedicant, because ofits prolonged action.…”

Section: Resultsmentioning

confidence: 99%

Comparison of the Effects of Atropine and Glycopyrrolate on Various End-Organs

Mirakhur¹,

Dundee²

1982

Survey of Anesthesiology

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Summary: Atropine and glycopyrrolate (glycopyrronium bromide), a quaternary ammonium drug, were evaluated in volunteers following intramuscular administration with respect to effects on various end-organs with cholinergic innervation. Glycopyrrolate appears to be five to six times more potent than atropine in its antisialogogue effect and also exhibits a selective, though prolonged, effect on salivary secretion and sweat gland activity. It has minimal cardiovascular, ocular and central nervous system effects. hntroduction Atropine has for long been one of the main anticholinergic drugs employed in anaesthetic practice. It has significant actions on most systems which are cholinergically innervated. However, it suffers from some disadvantages. These include a relatively short duration of action (Eger 1962 Glycopyrrolate (glycopyrronium bromide) is a quaternary ammonium anticholinergic compound which, being highly polar, does not cross the blood-brain barrier. Initial studies in volunteers have shown it to be a potent antisialogogue agent (Wyant & Kao 1974). The present paper compares some of the actions of intramuscular atropine and glycopyrrolate in volunteers. MethodsSix adult volunteer anaesthetists participated in the study, the nature of which had been fully explained to them. Each received three doses of atropine (0.5, 1.0 and 2.0 mg) and three doses of glycopyrrolate (0.1, 0.2 and 0.4 mg) given by deep intramuscular injection. The subjects were each studied for six hours, at intervals of one week. Drugs were given in random order and observations made before and for six hours after administration.Baseline observations were recorded after resting for 30 minutes. Measurements included heart rate, blood pressure, salivary secretion, sweat gland activity, pupillary size, oral temperature and the near point of vision. The detailed methodology has been described previously .Due to the skewed distribution of measurements of salivary secretion and sweat gland activity, these data were subjected to a Wilcoxan matched-pairs signed-ranks test for determination of their statistical significance, other results being subjected to a paired t test. The dose-response curves were subjected to an analysis of covariance. ResultsThe means ages and weights of the volunteers were 32 years and 62 kg respectively. Salivary secretion: The effects ofboth drugs were dose-related (Figure 1). The salivary secretion was reduced by 43, 72 and 85% with 0.5, 1.0 and 2.0 mg atropine respectively, the peak effect

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“…However, it is possible that doses in excess of those used here may produce tachycardia, but then the dryness would be very intense and extremely unpleasant. Though studies of the heart rate with doses of glycopyrrolate up to 0.2 mg intravenously showed no significant rise in heart rate (Wyant & Kao 1974, Mirakhur 1979, doses of 0.5 mg administered in a mixture with 2.5 mg neostigmine have effectively prevented bradycardia induced by neostigmine (Ramamurthy et al 1972, Ostheimer 1977, Mirakhur et al 1977. However, we do not recommend the routine use of glycopyrrolate as a premedicant, because ofits prolonged action.…”

Section: Discussionmentioning

confidence: 99%

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

Mirakhur

Dundee

1980

J R Soc Med

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Glycopyrrolate as a substitute for atropine in neostigmine reversal of muscle relaxant drugs

Cited by 49 publications

References 18 publications

Glycopyrrolate—neostigmine Mixture for Antagonism of Neuromuscular Block: Comparison With Atropine—neostigmine Mixture

Glycopyrrolate—neostigmine Mixture for Antagonism of Neuromuscular Block: Comparison With Atropine—neostigmine Mixture

Comparison of the Effects of Atropine and Glycopyrrolate on Various End-Organs

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

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Glycopyrrolate as a substitute for atropine in neostigmine reversal of muscle relaxant drugs

Cited by 49 publications

References 18 publications

Glycopyrrolate—neostigmine Mixture for Antagonism of Neuromuscular Block: Comparison With Atropine—neostigmine Mixture

Glycopyrrolate—neostigmine Mixture for Antagonism of Neuromuscular Block: Comparison With Atropine—neostigmine Mixture

Comparison of the Effects of Atropine and Glycopyrrolate on Various End-Organs

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

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