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Randomized Controlled Trial
. 2024 Apr 1;24(1):123.
doi: 10.1186/s12871-024-02512-x.

The effect of glycopyrrolate vs. atropine in combination with neostigmine on cardiovascular system for reversal of residual neuromuscular blockade in the elderly: a randomized controlled trial

Yanping Wang  1 , Liyuan Ren  2 , Yanshuang Li  2 , Yinhui Zhou  2 , Jianjun Yang  2
Affiliations
Randomized Controlled Trial

The effect of glycopyrrolate vs. atropine in combination with neostigmine on cardiovascular system for reversal of residual neuromuscular blockade in the elderly: a randomized controlled trial

Yanping Wang et al. BMC Anesthesiol. .

Abstract

Background: Glycopyrrolate-neostigmine (G/N) for reversing neuromuscular blockade (NMB) causes fewer changes in heart rate (HR) than atropine-neostigmine (A/N). This advantage may be especially beneficial for elderly patients. Therefore, this study aimed to compare the cardiovascular effects of G/N and A/N for the reversal of NMB in elderly patients.

Methods: Elderly patients aged 65-80 years who were scheduled for elective non-cardiac surgery under general anesthesia were randomly assigned to the glycopyrrolate group (group G) or the atropine group (group A). Following the last administration of muscle relaxants for more than 30 min, group G received 4 ug/kg glycopyrrolate and 20 ug/kg neostigmine, while group A received 10 ug/kg atropine and 20 ug/kg neostigmine. HR, mean arterial pressure (MAP), and ST segment in lead II (ST-II) were measured 1 min before administration and 1-15 min after administration.

Results: HR was significantly lower in group G compared to group A at 2-8 min after administration (P < 0.05). MAP was significantly lower in group G compared to group A at 1-4 min after administration (P < 0.05). ST-II was significantly depressed in group A compared to group G at 2, 3, 4, 5, 6, 7, 8, 9, 11, 13, 14, and 15 min after administration (P < 0.05).

Conclusions: In comparison to A/N, G/N for reversing residual NMB in the elderly has a more stable HR, MAP, and ST-II within 15 min after administration.

Keywords: Atropine; Cardiovascular system; Elderly; Glycopyrrolate; Neostigmine.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of study
Fig. 2
Fig. 2
Heart rate at various times after administration
Fig. 3
Fig. 3
Mean arterial pressure at various times after administration
Fig. 4
Fig. 4
ST segment changes in lead II at various times after administration
See this image and copyright information in PMC

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References

    1. Blobner M, Frick CG, Stäuble RB, Feussner H, Schaller SJ, Unterbuchner C, et al. Neuromuscular blockade improves surgical conditions (NISCO) Surg Endosc. 2015;29(3):627–36. doi: 10.1007/s00464-014-3711-7. - DOI - PubMed
    1. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology. 2003;98(5):1049–56. doi: 10.1097/00000542-200305000-00005. - DOI - PubMed
    1. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Shear TD, Vender JS, et al. Residual neuromuscular block in the Elderly: incidence and clinical implications. Anesthesiology. 2015;123(6):1322–36. doi: 10.1097/ALN.0000000000000865. - DOI - PubMed
    1. Sauer M, Stahn A, Soltesz S, Noeldge-Schomburg G, Mencke T. The influence of residual neuromuscular block on the incidence of critical respiratory events. A randomised, prospective, placebo-controlled trial. Eur J Anaesthesiol. 2011;28(12):842–8. doi: 10.1097/EJA.0b013e328345cd11. - DOI - PubMed
    1. Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111(1):120–8. doi: 10.1213/ANE.0b013e3181da832d. - DOI - PubMed

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