The effect of glycopyrrolate (Robinul) on the lower oesophageal sphincter

Brock‐Utne, John G.; Rubin, Joseph; Welman, Shaun; Dimopoulos, G.; Moshal, M G; Downing, J. W.

doi:10.1007/bf03005073

Cited by 29 publications

(2 citation statements)

References 12 publications

(1 reference statement)

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“…38 Both anticholinergics have been shown to decrease lower esophageal sphincter pressure in adults; however, the effect has a more rapid onset and longer duration in glycopyrrolate. 39,40 Whether this difference is responsible for our observed outcome remains unclear.…”

Section: Discussionmentioning

confidence: 92%

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Green

Roback²,

Krauss

2010

Academic Emergency Medicine

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Objectives: Adjunctive anticholinergics are commonly administered during emergency department (ED) ketamine sedation in children under the presumption that drying oral secretions should decrease the likelihood of airway and respiratory adverse events. Pharmacologic considerations suggest that glycopyrrolate might exhibit a superior adverse effect profile to atropine. The authors contrasted the adverse events noted with use of each of these anticholinergics in a large multicenter observational database of ketamine sedations.Methods: This was a secondary analysis of an observational database of 8,282 ED ketamine sedations assembled from 32 prior series. The authors compared the relative incidence of six adverse events (airway and respiratory adverse events, laryngospasm, apnea, emesis, recovery agitation, and clinically important recovery agitation) between children who received coadministered atropine, glycopyrrolate, or no anticholinergic. Multivariable analysis using the specific anticholinergic as a covariate was performed, while controlling for other known predictors.Results: Atropine was associated with less vomiting (5.3%) than either glycopyrrolate (10.7%) or no anticholinergic (11.4%) in both unadjusted and multivariable analyses. Glycopyrrolate was associated with significantly more airway and respiratory adverse events (6.4%) than either atropine (3.3%) or no anticholinergic (3.0%) and similarly more clinically important recovery agitation (2.1% vs. 1.2 and 1.3%). There were, however, no differences noted in odds of laryngospasm and apnea.Conclusions: This secondary analysis unexpectedly found that the coadministered anticholinergic atropine exhibited a superior adverse event profile to glycopyrrolate during ketamine sedation. Any such advantage requires confirmation in a separate trial; however, our data cast doubt on the traditional premise that glycopyrrolate might be superior. Further, neither anticholinergic showed efficacy in decreasing airway and respiratory adverse events.ACADEMIC EMERGENCY MEDICINE 2010; 17:157-162 ª

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Section: Discussionmentioning

confidence: 92%

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Green

Roback²,

Krauss

2010

Academic Emergency Medicine

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“…Glycopyrrolate reduces tone in the LES and thus increases the theoretical risk of reflux 47 [V]. It might, however, reduce the acidity and volume of gastric contents, but less predictably than cimetidine [48][49][50][51] [II and III].…”

Section: Introductionmentioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

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Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high‐grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre‐operative gastric emptying is rarely indicated. For pre‐oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre‐oxygenation in the obese patients should be performed in the head‐up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1–1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

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Case 29: Controversy

Brock‐Utne

2015

Clinical Research

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The effect of glycopyrrolate (Robinul) on the lower oesophageal sphincter

Cited by 29 publications

References 12 publications

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Anticholinergics and Ketamine Sedation in Children: A Secondary Analysis of Atropine Versus Glycopyrrolate

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Case 29: Controversy

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