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

Mirakhur, R. K.; Dundee, John W.; Clarke, R.S.J.

doi:10.1093/bja/49.8.825

Cited by 67 publications

(23 citation statements)

References 18 publications

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Section: Methodsmentioning

confidence: 99%

“…Heart rate and blood pressure were monitored continuously during drug infusion. To reduce the potential of side effects, 0.2 mg of the peripheral cholinergic antagonist glycopyrrolate was administered (18,19).The publication costs of this article were defrayed in part by page charge payment. This article must therefore be hereby marked ''advertisement'' in accordance with 18 U.S.C.…”

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confidence: 99%

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Cholinergic stimulation alters performance and task-specific regional cerebral blood flow during working memory

Furey

Pietrini

Haxby

et al. 1997

Proc. Natl. Acad. Sci. U.S.A.

139

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Modulation of the cholinergic neurotransmitter system results in changes in memory performance, including working memory (WM), in animals and in patients with Alzheimer disease. To identify associated changes in the functional brain response, we studied performance measures and regional cerebral blood f low (rCBF) using positron emission tomography (PET) in healthy subjects during performance of a WM task. Eight control subjects received an infusion of saline throughout the study and 13 experimental subjects received a saline infusion for the first 2 scans followed by a continuous infusion of physostigmine, an acetylcholinesterase inhibitor, for the subsequent 8 scans. rCBF was measured using H 2 15 O and PET in a sequence of 10 PET scans that alternated between rest and task scans. During task scans, subjects performed the WM task for faces. Physostigmine both improved WM efficiency, as indicated by faster reaction times, and reduced WM task-related activity in anterior and posterior regions of right midfrontal gyrus, a region shown previously to be associated with WM. Furthermore, the magnitudes of physostigmine-induced change in reaction time and right midfrontal rCBF correlated. These results suggest that enhancement of cholinergic function can improve processing efficiency and thus reduce the effort required to perform a WM task, and that activation of right prefrontal cortex is associated with task effort.Working memory (WM) refers to processes that maintain temporary, active representations of information so that they are available for further processing or recall (1, 2). The cholinergic neurotransmitter system is associated with WM, insofar as cholinergic agonists improve performance (3-5) and antagonists impair performance (6, 7) on WM tasks. Physostigmine, an acetylcholinesterase inhibitor that increases the duration of action of acetylcholine at the synapse, also improves performance on WM tasks in animals and in patients with Alzheimer disease (3-5, 8, 9). Functional brain imaging studies of humans have identified brain regions involved in the performance of object and spatial WM tasks, including occipital, temporal, parietal, and prefrontal cortical areas (10 -13). On object WM tasks, functional imaging studies in humans, as well as lesion and single neuron recording studies in nonhuman primates, indicate that posterior occipitotemporal cortex is associated more with perceptual processing, whereas prefrontal cortex is associated more with maintaining an active representation of the stimulus after it has been removed from view (10, 14 -17). Although it has been shown that cholinergic modulation alters WM performance, the site of modulation in the distributed neural system that mediates WM has yet to be determined. Therefore, we decided to investigate changes in regional cerebral blood f low (rCBF) and behavioral performance (reaction time) associated with cholinergic stimulation during a WM task. MATERIALS AND METHODSTwenty-one right-handed healthy volunteers participated in the study. Each p...

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Cholinergic stimulation alters performance and task-specific regional cerebral blood flow during working memory

Furey

Pietrini

Haxby

et al. 1997

Proc. Natl. Acad. Sci. U.S.A.

139

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“…(0.02 mg) before the physostigmine infusion to minimize peripheral side effects (Mirakhur et al, 1977;Oduro, 1975). For the placebo infusions, the same infusion schedule was used with saline.…”

Section: Experiments 1: Effect Of Enhancing Cholinergic Activity On Sementioning

confidence: 99%

Selective Effects of Cholinergic Modulation on Task Performance during Selective Attention

Furey

Pietrini

Haxby

et al. 2007

Neuropsychopharmacol

102

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The cholinergic neurotransmitter system is critically linked to cognitive functions including attention. The current studies were designed to evaluate the effect of a cholinergic agonist and an antagonist on performance during a selective visual attention task where the inherent salience of attended/unattended stimuli was modulated. Two randomized, placebo-controlled, crossover studies were performed, one (n ¼ 9) with the anticholinesterase physostigmine (1.0 mg/h), and the other (n ¼ 30) with the anticholinergic scopolamine (0.4 mc/kg). During the task, two double-exposure pictures of faces and houses were presented side by side. Subjects were cued to attend to either the face or the house component of the stimuli, and were instructed to perform a matching task with the two exemplars from the attended category. The cue changed every 4-7 trials to instruct subjects to shift attention from one stimulus component to the other. During placebo in both studies, reaction time (RT) associated with the first trial following a cued shift in attention was longer than RT associated with later trials (po0.05); RT also was significantly longer when attending to houses than to faces (po0.05). Physostigmine decreased RT relative to placebo preferentially during trials greater than one (po0.05), with no change during trial one; and decreased RT preferentially during the attention to houses condition (po0.05) vs attention to faces. Scopolamine increased RT relative to placebo selectively during trials greater than one (po0.05), and preferentially increased RT during the attention to faces condition (po0.05). The results suggest that enhancement or impairment of cholinergic activity preferentially influences the maintenance of selective attention (ie trials greater than 1). Moreover, effects of cholinergic manipulation depend on the selective attention condition (ie faces vs houses), which may suggest that cholinergic activity interacts with stimulus salience. The findings are discussed within the context of the role of acetylcholine both in stimulus processing and stimulus salience, and in establishing attention biases through top-down and bottom-up mechanisms of attention.

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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: 88%

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

Mirakhur

Dundee

1980

J R Soc Med

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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.

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

Cited by 67 publications

References 18 publications

Cholinergic stimulation alters performance and task-specific regional cerebral blood flow during working memory

Cholinergic stimulation alters performance and task-specific regional cerebral blood flow during working memory

Selective Effects of Cholinergic Modulation on Task Performance during Selective Attention

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

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

Cited by 67 publications

References 18 publications

Cholinergic stimulation alters performance and task-specific regional cerebral blood flow during working memory

Cholinergic stimulation alters performance and task-specific regional cerebral blood flow during working memory

Selective Effects of Cholinergic Modulation on Task Performance during Selective Attention

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