Scopolamine Use in the Perioperative Patient: A Systematic Review

Abstract

Scopolamine is an antiemetic agent used for postoperative nausea and vomiting prevention; however, it has anticholinergic effects (eg, bradycardia, dry mouth, dizziness, visual disturbances). Avoiding scopolamine use in specific populations is crucial to prevent adverse effects and harm to patients. This systematic review describes the anticholinergic effects of scopolamine in perioperative patient populations. After searching the available literature, we reviewed the eligible articles to determine whether they met the inclusion criteria (eg, full text, English language, included a discussion of scopolamine's anticholinergic effects in perioperative patients). Twenty-six articles were included in this review. We used The Johns Hopkins Research Evidence Appraisal Tool to appraise the literature. The results of this literature review reveal that clinicians should avoid administering scopolamine to certain perioperative patient populations (ie, pediatric, older adult).

Acetylcholine Muscarinic Receptors in Ventral Hippocampus Modulate Stress-Induced Anxiety-Like Behaviors in Mice

“…A series of studies suggest that scopolamine has antidepressant effects in depressed humans (Dulawa and Janowsky, 2019), shows promise for the treatment of opioid use disorder (Jensen et al, 2018), and has significant postoperative nausea and vomiting (PONV) therapeutic efficacy (Kassel et al, 2018). In this study, we found that scopolamine had a significant effect on social behavior in mice with chronic stress (Figures 4H,I).…”

“…Maladaptive responses to chronic stress are associated with the onset and exacerbation of emotional abnormalities, including anxiety disorders and social avoidance (Dias-Ferreira et al, 2009;McEwen and Morrison, 2013;McEwen et al, 2015;Sandi and Haller, 2015). It is reported that more than 30% of adults and adolescents present an anxiety disorder in their lifetime and that 25%-80% of patients admitted to the hospital for surgery experienced preoperative anxiety (Bluett et al, 2014;Kassel et al, 2018). The anxiety impacts negatively influence the quality of life of patients.…”

“…The anxiety impacts negatively influence the quality of life of patients. Furthermore, during postsurgical recovery, anxiety negatively influences the intensity of postoperative pain and analgesia requirement and even increases postoperative morbidity and mortality in certain types of surgery (Kassel et al, 2018). Various treatments, such as acceptance and commitment therapy, cognitive therapy, music therapy, and pharmacological interventions, have been applied to patients suffering from anxiety disorder.…”

“…However, currently available treatments for anxiety disorders are inadequate. For instance, the drugs lorazepam and pregabalin, intended to treat anxiety, have failed to decrease preoperative anxiety and postoperative pain (Kassel et al, 2018). Currently, mechanisms underlying anxiety need to be fully understood for developing adequate treatments.…”

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

“…Kassel et al . 218 concluded that scopolamine should be reconsidered as a routine agent for PONV prevention in the general surgical population but should be avoided in both pediatric and elderly surgical populations.…”