Glycopyrrolate Compared with Atropine in Prevention of the Oculocardiac Reflex during Eye-muscle Surgery

Der okulokardiale Reflex bei Blepharoplastiken

“…Dabei fanden wir eine hohe Anzahl von Patienten mit signifikanten Herzfrequenzänderun-gen während der Manipulation an den orbitalen Fettkörpern. [2,7,13,18]. Eine retrobulbäre Blockade selbst birgt eine äußerst hohe Gefahr zur Reflexauslösung und kann zudem noch zu retrobulbären Hämatomen führen [12].…”

“…Eine retrobulbäre Blockade selbst birgt eine äußerst hohe Gefahr zur Reflexauslösung und kann zudem noch zu retrobulbären Hämatomen führen [12]. Prophylaktische anticholinerge Medikation müsste in sehr hohen Dosen appliziert werden, die zu Tachykardien oder signifikanten Rhythmusstörungen führen können [13]. …”

Different properties of the bradycardia produced by neostigmine and edrophonium in the cat

“…It has been claimed that glycopyrrolate has a smaller effect on basal heart rate than that of atropine, based on clinical studies which were complicated by previous administration of drugs with muscarinic effects (e.g., atropine, pancuronium and anticholinesterases), varying depths of anaesthesia, or unequal doses of glycopyrrolate and atropine. [28][29][30][31][32][33] Undoubtedly, the fact that glycopyrrolate is prepared as a 0.2 mg. m1-1 solution whereas atropine is 0.6 mg. ml -~, further contributes to the clinical impression that glycopyrrolate is less potent than atropine on basal heart rate. It is important to realise that, in clinical studies which were more specifically designed to compare the effects of glycopyrrolate and atropine on basal heart rate, it has been shown that glycopyrrolate is at least as potent (if not more so) as atropine.…”

The Trigeminal Nerve and the Autonomous Nerve System

“…45,46 In 2002, Cha et al described two unexpected episodes of asystole after transaction of the sensory roots of the trigeminal nerves. During surgery near the posterior third of the falx, consideration should be given to the potential of eliciting a bilateral TCR, causing marked hypotension and bradycardia or other dysrhythmias.…”