Comparison of I.V. Glycopyrrolate and Atropine in the Prevention of Bradycardia and Arrhythmias Following Repeated Doses of Suxamethonium in Children

Green, D.W.; Bristow, Aubrey; Fisher, Megan

doi:10.1093/bja/56.9.981

Cited by 19 publications

(4 citation statements)

References 5 publications

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“…The indications were chosen after an examination of the available literature according to those recommended by various authors. 5,7,[9][10][11][12] For each of these indications, the respondent was asked whether they would give prophylactic atropine to the following patient groups: neonates (defined as being less than 44 weeks post-conceptual age), infants (up to one year of age), children, or adults.…”

Section: Methodsmentioning

confidence: 99%

A National Survey of Atropine Use by Australian Anaesthetists

Parnis

Walt

1994

Anaesth Intensive Care

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All Fellows of the Faculty of Anaesthetists, Royal Australasian College of Surgeons (now Australian and New Zealand College of Anaesthetists) were surveyed by mail regarding their use of prophylactic atropine. They were asked whether their usual practice was to give atropine for the following indications: premedication, induction of anaesthesia, intubation of the trachea, one dose of suxamethonium, a second dose of suxamethonium, halothane anaesthesia, oropharyngeal surgery, bronchoscopy and eye surgery. For each indication they were asked for details regarding their practice concerning neonates, infants, children and adults. The large response rate of 86% of Fellows returning a survey form ensured that the survey was representative of Australian anaesthetic practice. Results indicate a wide variation in practice regarding the prophylactic use of atropine, with neonates, infants and children more likely to receive prophylactic atropine than adults. The majority do not give prophylactic atropine as premedication, but may give it in the younger age groups at induction, and many (67%) only give it if they are to administer suxamethonium to a child. The only indication for which a convincing majority (>80%) of anaesthetists agreed that prophylactic atropine should be given was when a repeated dose of suxamethonium was to be given to neonates, infants or children. A large proportion of anaesthetists (> 80%) agreed that atropine is not necessary prior to halothane anaesthesia in all age groups, nor as premedication, at induction, at intubation, prior to oropharyngeal surgery or prior to eye surgery in adults. These results were compared with the practice at a major paediatric hospital where the practice is not to use routine prophylactic atropine.

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Section: Methodsmentioning

confidence: 99%

A National Survey of Atropine Use by Australian Anaesthetists

Parnis

Walt

1994

Anaesth Intensive Care

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“…Green and cohorts studied heart rate changes in 26 anesthetized children being paralyzed with succinylcholine. 6 Ten were premedicated with glycopyrrolate, 10 with atropine, and 6 served as a control group. The patients received a median of 3 doses of succinylcholine.…”

Section: Evidence For Atropine Usementioning

confidence: 99%

“…1,2 Articles in the emergency medicine and pediatric literature have repeatedly recommended that children receive atropine before succinylcholine to prevent bradycardia and asystole. 1,[3][4][5][6][7] Atropine is thought to prevent bradycardia related to 2 different mechanisms. First, succinylcholine itself causes bradycardia, although the exact mechanism of this is unclear.…”

Section: Introductionmentioning

confidence: 99%

Myth: Atropine should be administered before succinylcholine for neonatal and pediatric intubation

Fleming

McCollough

Henderson

2005

CJEM

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Succinylcholine is often used to facilitate neonatal and pediatric rapid sequence intubation in the emergency department, and most relevant literature recommends administering atropine prior to succinylcholine to reduce the risk of bradycardia. Given the potential complications associated with combining these medications, we searched the published literature for evidence supporting this practice. Most studies recommending atropine premedication were undertaken in the operating room setting and pertained to repeated succinylcholine dosing. Furthermore, there is little published evidence to indicate that succinylcholine-related bradycardia is a clinically important side effect. Several authors have called for the practice to cease, but, to date, these calls have gone unheeded. We found no evidence supporting atropine's use in pediatric patients prior to single-dose succinylcholine. Atropine premedication for emergency department rapid sequence intubation is unnecessary and should not be viewed as a “standard of care.”

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“…Block of M 2 and M 3 subtypes appears to mediate increased heart frequency (M 2 block) and inhibition of salivation and bronchial secretion (M 3 block) produced by the antimuscarinic drugs atropine and glycopyrronium [11,12]. Both antimuscarinic drugs are used widely as perioperative medication to prevent cardiac arrhythmia and bradycardia [13][14][15][16], and to inhibit salivation and excessive respiratory tract secretions [17][18][19][20][21]. When glycopyrronium and atropine antisialagogic activity are comparable, glycopyrronium is thought to cause less tachycardia while simultaneously blocking bradyarrhythmias more effectively [22][23][24][25][26] than atropine.…”

mentioning

confidence: 99%

Atropine and glycopyrronium show similar binding patterns to M 2 (cardiac) and M 3 (submandibular gland) muscarinic receptor subtypes in the rat

Gómez

Bellido

Cuesta

1995

British Journal of Anaesthesia

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Atropine and glycopyrronium are frequently used for premedication to reduce oral and respiratory secretions and prevent bradycardia. Glycopyrronium is said to have similar antisialagogue effects, but is less likely to cause significant tachycardia than atropine. Different antimuscarinic receptor selectivity patterns could explain the differences. The aim of this investigation was to determine the possible selectivity of glycopyrronium for M2 and M3 muscarinic receptor subtypes. Muscarinic receptor subtypes in Wistar rat ventricle and submandibular gland homogenates were characterized with [3H]-N-methylscopolamine ([3H]-NMS) by ligand binding studies. Inhibition of [3H]-NMS binding by non-labelled compounds showed the following order: in rat ventricle: glycopyrronium > atropine >> otenzepad > hexahydrosiladiphenidol (HHSiD) > pirenzepine; in rat submandibular gland: glycopyrronium > atropine >> HHSiD >> pirenzepine > otenzepad. These were similar to the expected order of frequency of M2 and M3 subtypes, respectively. Glycopyrronium showed similarly high affinities for both M2 (Ki = 1.889 (SEM 0.049) nmol litre-1) and M3 (Ki = 1.686 (0.184) nmol litre-1) subtypes. Glycopyrronium bound to a homogeneous population of binding sites in both tissues and showed no selectivity for M2 or M3 muscarinic receptor subtypes.

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Comparison of I.V. Glycopyrrolate and Atropine in the Prevention of Bradycardia and Arrhythmias Following Repeated Doses of Suxamethonium in Children

Cited by 19 publications

References 5 publications

A National Survey of Atropine Use by Australian Anaesthetists

A National Survey of Atropine Use by Australian Anaesthetists

Myth: Atropine should be administered before succinylcholine for neonatal and pediatric intubation

Atropine and glycopyrronium show similar binding patterns to M 2 (cardiac) and M 3 (submandibular gland) muscarinic receptor subtypes in the rat

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