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SummaryColonic intraluminal pressure was recorded in eight patients receiving either atropine 1.2 mg (n = 4) or glycopyrronium 0.6 mg (n = 4) intravenously in a randomised, double-blind fashion and followed after 5 minutes by neostigmine 2.5 mg. Estimations of total colonic activity were made from the area under the recording of intraluminal pressure. There were no signijicant difSerences in mean intraluminal pressures or total colonic activity between the two groups. It is concluded that glycopyrronium offers no advantage over atropine with respect to protection of the bowel against the effects of neostigmine. Key wordsParasympathetic nervous system; atropine, glycopyrronium. Antagonists, neuromuscular relaxants; neostigmine. Surgery; colonic anastomosis.The quaternary anticholinergic glycopyrronium bromide is a strong inhibitor of gastrointestinal motility' and it is used orally in the treatment of disorders of motility such as the irritable bowel syndrome and to provide intestinal hypotonia for various endoscopic and radiological procedure^.'^^ It is also used intravenously to counteract themuscariniceffectsofneostigmine during the reversal of neuromuscular blockade. The use of neostigmine for this purpose following anastomotic bowel surgery can result in the rupture of an intestinal a n a s t o m~s i s .~ Rupture may result from the increase in intestinal motility brought about by the neostigmine as this is frequently not abolished by atropine.s Although the efficacy of reversal of neuromuscular blockade with neostigmine and glycopyrronium has been well documented with regard t o neuroand cardiovascular".' ' parameters there is no information on their effect on gastrointestinal motility.The purpose of this study was to determine whether glycopyrronium offers better protection than atropine against the effects of neostigmine on bowel motility.

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The effects of a single intravenous bolus of labetalol (0.5 mglkg) on the cardiovascular, hyperglycaemic and adrenocortical responses to major colonic surgery were studied in five patients. Results were compared with five patients who received the same anaesthetic and had similar operations performed but who did not receive labetalol. It was observed that labetalol reduced the rises in heart rate and rate-pressure product that occur ai the time of skin incision but that it did not reduce the rise in mean arterial pressure. The rises in blood glucose and plasma cortisol were significantly less in the labetalol group after 30 minutes of surgery (p < 0.05).