Glycopyrrolate in Children

Warran, P.; Radford, P.; Manford, Margaret L.M.

doi:10.1093/bja/53.12.1273

Cited by 22 publications

(5 citation statements)

References 10 publications

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“…glycopyrrolate is identical. 17 Our results were similar to that study. Sigurdsson and colleagues reported that in children, the incidence of ventricular arrhythmias is increased after diazepam-atropine premedication, compared with that after diazepam-morphinehyoscine.…”

Section: Discussionsupporting

confidence: 92%

Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children

Annila¹,

Rorarius²,

Reinikainen³

et al. 1998

British Journal of Anaesthesia

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We studied the effect of anticholinergics on the incidence of cardiac arrhythmias during paediatric anaesthesia. ASA I-II children (n = 77) undergoing adenoidectomy were randomly allocated to three groups. Intravenous atropine 0.02 mg kg-1 was given in group A (n = 25), glycopyrrolate 0.004 mg kg-1 in group G (n = 27) and physiological saline in group P (n = 25) 3 min before the induction of anaesthesia. The children breathed spontaneously under halothane anaesthesia with 66% nitrous oxide in oxygen after induction with thiopentone and succinylcholine. Perioperative monitoring of the ECG (Holter recordings) and oxygen saturation was carried out. Ventricular tachycardia occurred in 16.0%, 18.5% and 12.0% of the children in groups A, G and P respectively (ns). The incidence of ventricular arrhythmias (ventricular tachycardia, ventricular bigeminy, ventricular premature beats > 10) was 20.0% in group A, 44.4% in group G and 36.0% in group P (ns). Bradycardia (< 70 beats min-1) was observed in 0.0%, 14.8% and 24.0% of patients in groups A, G and P respectively (A vs P, P < 0.05). The use of anticholinergics did not influence the incidence of ventricular arrhythmias during halothane anaesthesia in children. Bradycardia was more common in the placebo group than in the atropine group.

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Section: Discussionsupporting

confidence: 92%

Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children

Annila¹,

Rorarius²,

Reinikainen³

et al. 1998

British Journal of Anaesthesia

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“…Malling et al ( Malling et al, 1988 ) compared the combination of glycopyrrolate and atropine with neostigmine to antagonize residual muscle relaxation during hip arthroplasty in elderly patients undergoing general anesthesia and found no difference in postoperative awakening time between the two groups. In this trial, although one case of postarousal agitation occurred in group A (glycopyrrolate), no significant difference was observed in the overall time to arousal or quality of arousal between the two groups, thus further confirming the findings of Malling ( Malling et al, 1988 ) et al In addition, the doses of both glycopyrrolate and atropine were relatively conserved in our experiment, and no significant effects on the patients’ body temperature were found, similar to the findings of Warran et al ( Warran et al, 1981 ).…”

Section: Discussionsupporting

confidence: 92%

“…Despite several studies comparing the anti-salivary effects of glycopyrrolate and atropine, no consistent conclusions have been reached. For instance, Warran et al ( Warran et al, 1981 ) compared the oropharyngeal secretions (defined as oropharyngeal “moist” or “dry” depending on whether aspiration was required) during tracheal intubation, intraoperatively, and postoperatively in three groups that were given atropine (i.v), atropine (i.m) and glycopyrrolate (i.v) before anesthesia induction in children undergoing tonsillectomy and adenoidectomy. The results showed that there was no difference in oropharyngeal dryness at the time of intubation or in the postoperative period; however, glycopyrrolate was better at inhibiting gland secretion during surgery.…”

Section: Discussionmentioning

confidence: 99%

Effects of glycopyrrolate and atropine for oral secretions and perioperative hemodynamics in children undergoing tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled trial

Tao,

Tang,

Lin

et al. 2024

Front. Pharmacol.

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IntroductionGlycopyrrolate is commonly researched as a preoperative medication or in conjunction with cholinesterase inhibitors to counteract the lingering muscarinic effects of non-depolarizing muscarinic agents. However, studies have yielded inconsistent results regarding the superiority of glycopyrrolate over other anti-cholinergic drugs, such as atropine, particularly its effect on heart rate, blood pressure (BP), and glandular secretions. This study aimed to evaluate the differences in perioperative oral secretions, hemodynamics, and recovery quality with glycopyrrolate versus those with atropine before anesthesia induction in children undergoing tonsillectomy and adenoidectomy.MethodsIn this prospective, single-center, randomized, double-blind, controlled trial, a total of 103 children were randomly assigned to group A (n = 51, glycopyrrolate 0.005 mg/kg) or B (n = 52, atropine 0.01 mg/kg). The follow-up anesthetic induction and maintenance protocols were the same in both groups. Vital signs, duration of surgery, extubation time, degree of wetness around the vocal cords during tracheal intubation, weight of oral secretions, and perioperative complications were recorded.ResultsNo significant differences were observed in the degree of wetness around the vocal cords during tracheal intubation, as well as in the weight of oral secretions, duration of surgery, or extubation time, between the two groups. The intraoperative and postoperative heart rates were lower in group A than in group B (110.18 ± 10.58 vs. 114.94 ± 11.14, p = 0.028; 96.96 ± 10.81 vs. 103.38 ± 10.09, p = 0.002). The differences observed in the intraoperative and preoperative heart rates were lower in group A than in group B (23.84 ± 9.62 vs. 29.65 ± 8.75, p = 0.002). The differences observed in the postoperative and preoperative heart rates were lower in group A than in group B (10.63 ± 9.97 vs. 18.09 ± 9.39, p = 0.000).ConclusionGlycopyrrolate showed a smoother change in heart rate than atropine during and after tonsillectomy and adenoidectomy, with no effect on BP or recovery quality, and did not increase oral secretions. The findings indicate that glycopyrrolate can serve as an alternative to atropine to prevent secretions in anesthesia induction for tonsillectomy and adenoidectomy in children.Trial registration: This study was registered with the Chinese Clinical Trial Registry (Registration Number: ChiCTR2200063578; Date of Registration: 12/09/2022).

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“…Warran et al compared the effects of intravenous injection of atropine or glycopyrrolate prior to induction of anesthesia with those of preoperative oral atropine on oropharyngeal secretions after completion of general tracheal intubation, during and after surgery in children (de ned as oropharyngeal "moist" or "dry" by whether aspiration was required). The results did not differ between the three groups in terms of oropharyngeal dryness at the time of intubation and postoperatively, and the intraoperative effect of glycopyrrolate in inhibiting glandular secretion was better [25] . Lavis et al compared the effects of glycopyrrolate with atropine as a preoperative medication in children undergoing tonsillectomy and adenoidectomy and found no difference in the duration of postoperative dry mouth between the two groups [26] .Black et al compared the effects of glycopyrrolate and atropine in combination with neostigmine in children for muscarinic antagonism, de ning oropharyngeal conditions as 'dry', 'moist' and 'unacceptably moist', and found that although there was no statistical difference in the anti-salivary effect of the two drugs, the attending anesthetist subjectively felt that glycopyrrolate was more effective [27] .…”

Section: Discussionmentioning

confidence: 74%

Effects of glycopyrrolate and atropine on oral secretions and perioperative hemodynamics in children with tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled study

Tao

Lin

Lei

et al. 2023

Preprint

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Purpose To compare the effects of glycopyrrolate and atropine before induction of anesthesia on perioperative oral secretions, hemodynamics and recovery quality of tonsillectomy and adenoidectomy in children. Methods A total of 103 children were randomly divided into group A (glycopyrrolate, n = 51) and group B (atropine, n = 52). In Group A, glycopyrrolate 0.005mg/kg was injected intravenously before anesthesia induction. In Group B, atropine 0.01mg/kg was injected intravenously before anesthesia induction. The rest of the induction intubation and anesthesia maintenance protocol were the same. The vital signs of the children at each time points were recorded after they entered the operating room. The duration of operation, the duration of extubation, the weight of oral secretions, and the perioperative complications were recorded. Results There were no statistically significant differences in operation duration, extubation duration and oral secretion weight between the two groups. The intraoperative and postoperative heart rate was lower in Group A (glycopyrrolate) than in Group B (atropine) (115.19 ± 11.41 vs 120.10 ± 11.62, p = 0.033; 96.96 ± 10.81 vs 103.38 ± 10.09, p = 0.002). The amount of intraoperative and postoperative heart rate change was lower in Group A (glycopyrrolate) than in Group B (atropine) (28.86 ± 10.42 vs 34.81 ± 10.22, p = 0.004; 10.63 ± 9.97 vs 18.09 ± 9.39, p = 0.000). The incidence of perioperative complications did not differ between the two groups. Conclusions Compared to atropine, glycopyrrolate is more suitable for induction of anesthesia for paediatric tonsil and adenoid surgery as it has smoother heart rate changes with less volatility and does not affect blood pressure or postoperative arousal, nor does it increase oral secretions. Trial registration Chinese Clinical Trial Registry:(Registration number: ChiCTR2200063578); Date of Registration:12/09/2022

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Glycopyrrolate in Children

Cited by 22 publications

References 10 publications

Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children

Effect of pre-treatment with intravenous atropine or glycopyrrolate on cardiac arrhythmias during halothane anaesthesia for adenoidectomy in children

Effects of glycopyrrolate and atropine for oral secretions and perioperative hemodynamics in children undergoing tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled trial

Effects of glycopyrrolate and atropine on oral secretions and perioperative hemodynamics in children with tonsillectomy and adenoidectomy: a prospective, single-center, randomized, double-blind, controlled study

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