Prophylactic glycopyrrolate reduces hypotensive responses in elderly patients during spinal anesthesia: a randomized controlled trial

Hwang, Juck Joon; Min, Seong-Won; Kim, Chongsoo; Gil, Nam-Su; Kim, Eunkyoung

doi:10.1007/s12630-013-0064-y

Cited by 10 publications

(8 citation statements)

References 30 publications

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“…www.nature.com/scientificreports/ 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][25][26][27][28] . However, one study reported that only 2% of patients who did not undergo premedication experienced excess secretion that required treatment 29 .…”

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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“…[ 9 11 13 ] In contrast, some authors have shown hypotensive preventive effects of glycopyrrolate to be similar to ephedrine or phenylephrine. [ 14 15 16 ] Another contrasting study by Sahoo et al . showed decreased incidence of hypotension with ondansetron in parturients in comparison to placebo.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of effects of glycopyrrolate and ondansetron on nausea and vomiting in cesarean section under spinal anesthesia

Jain

Sharma

2015

Anesth Essays Res

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Background and Aim:Nausea and vomiting causes distress to patients and increases surgical complications. Though various antiemetics are available, their effectiveness and fetal safety profile when used in parturient remains debatable. This randomized, double-blind, comparative study was designed with an aim to compare the antiemetic effects of ondansetron and glycopyrrolate during cesarean section.Methods:Sixty-six parturients (American Society of Anesthesiologist physical status I-II) scheduled for elective cesarean section were randomized to receive intravenous ondansetron 4 mg (Group O, n = 32) or glycopyrrolate 0.2 mg (Group G, n = 31) before spinal anesthesia. Outcome measures studied were emesis, episodes of hypotension and bradycardia and pain, till 10 h postoperative. Statistical software used was Epi Info 7 and Microsoft Excel.Results:There was no significant difference in nausea and vomiting at all the study intervals between the two groups statistically. There was no difference in episodes of hypotension, but episodes of bradycardia were significantly less in glycopyrrolate group (26%) than in ondansetron group (56%) (P = 0.027). There was no difference in additional analgesic requirements. However, the incidence of dry mouth was significantly greater in glycopyrrolate group (21 [68%]) as compared to ondansetron group (5 [16%]) (P = 0.00).Conclusion:Effect of glycopyrrolate on nausea and vomiting during cesarean section are comparable to ondansetron, but with an increased incidence of dry mouth. Glycopyrrolate has no effect on hypotension or additional analgesic requirements, but the incidence of bradycardia is significantly less.

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“…Cephalad spread of local anesthetic increases the likelihood of bradycardia via two postulated mechanisms: the blockade of sympathetic cardiac accelerator fibers that arise at T1-T4 [10] and decreased venous return [17]. Even though in this study, a low incidence of bradycardia was found, post-intrathecal injection lowering of blood pressure was not apparently compensated by a rise in HR.…”

Section: Discussionmentioning

confidence: 61%

Impact evaluation of two different general anesthesia protocols (TIVA with propofol vs isoflurane) on the total number of interventions to treat cardiovascular depression or arousal/movement episodes in dogs undergoing orthopedic surgery receiving an intrathecal anesthesia

Sarotti¹,

Rabozzi²,

Franci

2016

The Journal of Veterinary Medical Science

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The aim of this prospective, randomized clinical trial was to compare the total number of anesthetic interventions (TNAI) performed by the anesthetist to treat cardiovascular depression or arousal/movement episodes in dogs receiving intrathecal and general anesthesia (GA), maintained using propofol-based TIVA (group P) or isoflurane (group I). Mean arterial pressure (MAP) before (T0) and 12 min after intrathecal anesthesia (T1) and intraoperative vasoactive consumption were also compared. The TNAI to deepen the anesthetic plane or to treat hemodynamic depression in the pre-surgical and intra-surgical period was calculated in forty-two client-owned dogs randomly assigned to group P or I. Ten dogs for each group complied with the inclusion criteria and were analyzed. In pre-surgical period, the TNAI was higher in Group I [2 (0–5)] than Group P [0 (0–2)] (P=0.022), and ephedrine consumption was also higher in Group I [75 (0–200) µg/kg)] than Group P [(0 (0–50)] (P=0.016). MAP (mmHg) in Group P was 79 (66–95) at T0 and 65 (59–86) at T1 and 67.5 (50–73) and 57 (53–66) in Group I, respectively. At T0 and T1, MAP was higher in Group P (P=0.005 and P=0.006, respectively). No differences were found between the two groups in the intrasurgical period (P>0.05). This study shows that the GA protocol can have a relevant impact on the TNAI performed by the anesthetist in the pre-surgical period of anesthesia, to treat cardiovascular depression or arousal/movement episodes in dogs receving intrathecal anesthesia.

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Prophylactic glycopyrrolate reduces hypotensive responses in elderly patients during spinal anesthesia: a randomized controlled trial

Cited by 10 publications

References 30 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

A comparative study of effects of glycopyrrolate and ondansetron on nausea and vomiting in cesarean section under spinal anesthesia

Impact evaluation of two different general anesthesia protocols (TIVA with propofol vs isoflurane) on the total number of interventions to treat cardiovascular depression or arousal/movement episodes in dogs undergoing orthopedic surgery receiving an intrathecal anesthesia

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