title: Glycopyrrolate during sevoflurane-remifentanil-based anaesthesia for cardiac catheterization of children with congenital heart disease.
abstract: BACKGROUND
  Remifentanil is recommended for use in procedures with painful intraoperative stimuli but minimal postoperative pain. However, bradycardia and hypotension are known side-effects. We evaluated haemodynamic effects of i.v. glycopyrrolate during remifentanil-sevoflurane anaesthesia for cardiac catheterization of children with congenital heart disease.
  
  
  METHODS
  Forty-five children undergoing general anaesthesia with remifentanil and sevoflurane were randomly allocated to receive either saline, glycopyrrolate 6 microg kg(-1) or glycopyrrolate 12 microg kg(-1). After induction of anaesthesia with sevoflurane, i.v. placebo or glycopyrrolate was administered. An infusion of remifentanil at the rate of 0.15 microg kg(-1) min(-1) was started, sevoflurane continued at 0.6 MAC and cisatracurium 0.2 mg kg(-1) was given. Heart rate (HR) and non-invasive arterial pressures were monitored and noted every minute for the first 10 min and then every 2.5 min for subsequent maximum of 45 min.
  
  
  RESULTS
  Baseline HR [mean (SD)] of 117 (20) beats min(-1) decreased significantly from 12.5 min onwards after starting the remifentanil infusion in the control group [106 (18) at 12.5 min and 99 (16) beats min(-1) at 45 min]. In the groups receiving glycopyrrolate, no significant decrease in HR was noticed. Glycopyrrolate at 12 microg kg(-1) induced tachycardia between 5 and 9 min after administration. Systolic and diastolic arterial pressures decreased gradually, but there were no significant differences in the pressures between groups.
  
  
  CONCLUSIONS
  I.V. glycopyrrolate 6 microg kg(-1) prevents bradycardia during general anaesthesia with remifentanil and sevoflurane for cardiac catheterization in children with congenital heart disease. Administering 12 microg kg(-1) of glycopyrrolate temporarily induces tachycardia and offers no additional advantage.
authors.affiliation: Department of Anaesthesiology, University Hospital Ghent, Ghent, Belgium. k.reyntjens@ugent.be
authors.forename: K
authors.initials: K
authors.lastname: Reyntjens
authors.forename: L
authors.initials: L
authors.lastname: Foubert
authors.forename: D
authors.initials: D
authors.lastname: De Wolf
authors.forename: G
authors.initials: G
authors.lastname: Vanlerberghe
authors.forename: E
authors.initials: E
authors.lastname: Mortier
mesh_terms: D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced / Q000517:prevention & control*; D006328:Cardiac Catheterization; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008738:Methyl Ethers; D010880:Piperidines / Q000009:adverse effects*; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane
chemical_list: D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D006024:Glycopyrrolate