Glycopyrronium and hypotension following combined spinal-epidural anaesthesia for elective Caesarean section in women with relative bradycardia.
The ability of glycopyrronium to reduce the severity of hypotension following subarachnoid block in parturients with a relative bradycardia was evaluated in a double-blind randomised controlled study. Women with a resting heart rate of < or = 80 beat x min(-1) presenting for elective Caesarean section were randomly allocated to receive either glycopyrronium 2 microg x kg(-1) or normal saline intravenously once positioned for combined spinal-epidural anaesthesia. Following spinal injection of 2.6 ml hyperbaric bupivacaine 0.5% and fentanyl 15 microg, women randomly allocated to the saline group were given 6 mg ephedrine so that all parturients received some prophylaxis against hypotension other than the fluid preload. Further ephedrine and fluid boluses were administered if mean arterial pressure fell 20% or more from resting values. Using a sequential analysis technique, analysis after the first 20 subjects indicated the study should be stopped, with no difference in ephedrine requirements or hypotension between the groups. We conclude that pretreatment with glycopyrronium 2 microg x kg(-1) is no more effective than 6 mg ephedrine in preventing hypotension following subarachnoid block in parturients with relatively low resting heart rates.
Rucklidge
M W M
MW
Magill Department of Anaesthesia, Intensive Care & Pain Management, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Durbridge
J
J
Barnes
P K
PK
Yentis
S M
SM
D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects; D002585:Cesarean Section; D004311:Double-Blind Method; D004809:Ephedrine / Q000627:therapeutic use; D005260:Female; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011247:Pregnancy; D012965:Sodium Chloride / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D018727:Muscarinic Antagonists; D014662:Vasoconstrictor Agents; D012965:Sodium Chloride; D004809:Ephedrine; D006024:Glycopyrrolate