Glycopyrrolate reduces nausea during spinal anaesthesia for caesarean section without affecting neonatal outcome

Abstract

We have tested the hypotheses that glycopyrrolate, administered immediately before induction of subarachnoid anaesthesia for elective Caesarean section, reduces the incidence and severity of nausea, with no adverse effects on neonatal Apgar scores, in a double-blind, randomized, controlled study. Fifty women received either glycopyrrolate 200 micrograms or saline (placebo) i.v. during fluid preload, before induction of spinal anaesthesia with 2.5 ml of 0.5% isobaric bupivacaine. Patients were questioned directly regarding nausea at 3-min intervals throughout operation and asked to report symptoms as they arose. The severity of nausea was assessed using a verbal scoring system and was treated with increments of i.v. ephedrine and fluids. Patients in the group pretreated with glycopyrrolate reported a reduction in the frequency (P = 0.02) and severity (P = 0.03) of nausea. Glycopyrrolate also reduced the severity of hypotension, as evidenced by reduced ephedrine requirements (P = 0.02). There were no differences in neonatal Apgar scores between groups.

Effect of low dose ketamine versus dexamethasone on intraoperative nausea and vomiting during cesarean section under spinal anesthesia

“…Few studies examined the effect of a ketamine on the incidence of nausea and vomiting during cesarean section by spinal anesthesia The sympatho-mimetic and vagolytic properties of ketamine encouraged us to examine its effects on IONV and compare it to dexamethasone which examined by many author. Ure D, et al studied the effect of glycopyrolate in prevention of intraoperative nausea during CS relying on its vagolytic effect, the incidence of IONV reduced from 68% in the placebo group to 42% in the glycopyrolate group [14]. Shabana et al studied the effect of 0.5 mg/kg ketamine on IONV, they showed significant reduction (P value 0.004) in nausea in the ketamine group compared with placebo group, also showed statistically insignificant reduction in vomiting in ketamine versus placebo group (2.3% versus 4.6%) [15], and the majority of hypotensive episodes occurs during the infusion time of ketamine.…”

Prophylactic use of IV atropine for prevention of spinal anesthesia induced hypotension and bradycardia in elderly: a randomized controlled trial

“…Intramuscular atropine has also been studied, but Hirabayashi et al, [17] did not demonstrate any beneficial effect in hemodynamic stability during SA because the absorption of IM atropine may be unpredictable, and the onset may have been too slow in comparison to the onset of hypotension after SA. Another anticholinergic agent, glycopyrrolate, when administered IV after SA increased HR and reduced the severity of hypotension [18] in women presenting for elective cesarean section, reducing ephedrine requirements (p=0.002).…”

Intraoperative nausea and vomiting during cesarean section under regional anesthesia

“…6 The overall incidence of IONV during regional anesthesia for cesarean section is extremely variable, up to 80%, depending on the anesthetic technique used (spinal, epidural or combined spinal-epidural) and on the preventive and therapeutic measures taken (Table 1). [7][8][9][10][11][12][13][14][15] The incidence of IONV may also vary significantly according to the stages of the surgical procedure (e.g. pre-delivery vs. post-delivery), different factors being implicated in the etiology.…”