Prophylactic glycopyrrolate reduces hypotensive responses in elderly patients
during spinal anesthesia: a randomized controlled trial.
Author(s): Hwang J(1), Min S, Kim C, Gil N, Kim E, Huh J.
Affiliation(s): Author information:
(1)Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center,
Boramae-ro, Dongjak-gu, Seoul, 156-707, Republic of Korea.
Publication date & source: 2014, Can J Anaesth. , 61(1):32-8
BACKGROUND: Hypotension during spinal anesthesia is a serious complication in
elderly patients. We evaluated the effect of glycopyrrolate on hypotensive
responses in elderly patients undergoing spinal anesthesia.
METHODS: Sixty-six patients older than 60 yr of age scheduled for elective
surgery with spinal anesthesia were included in the study. They received either
glycopyrrolate 0.2 mg (group G) or normal saline (group C) intramuscularly 15 min
before spinal anesthesia. The following outcomes were evaluated after the
induction of spinal anesthesia: the incidence of hypotension and bradycardia, the
ephedrine requirement, mean arterial pressure, heart rate, and the incidence of
nausea and vomiting.
RESULTS: Twenty-three of 33 (70.0%) patients in group C experienced hypotension
compared with nine of 33 (27.3%) patients in group G (difference = 42.7%; 95%
confidence interval [CI]: 18.4 to 60.2; P = 0.001). The median [interquartile
range] amount of ephedrine required was 5 [0-15] mg in group C compared with 0
[0-5] mg in group G (difference = 5.0 mg; 95% CI: 2.7 to 7.3; P = 0.001). Nine
(27.3%) patients in group C experienced nausea and vomiting compared with 2
(6.1%) in group G (difference = 21.2%; 95% CI: 3.0 to 38.7; P = 0.044). Three
(9.1%) patients in group C experienced bradycardia compared with 1 (3.0%) patient
in group G (difference = 6.1%; 95% CI: -7.6 to 20.8; P = 0.613).
CONCLUSION: Prophylactic intramuscular glycopyrrolate reduced the occurrence and
severity of hypotensive responses, the requirement for ephedrine, and the
incidence of nausea and vomiting in elderly patients undergoing spinal
anesthesia. The trial was registered at the Clinical Research Information
Service, Republic of Korea (KCT0000556).
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