Key result
Prophylactic intravenous glycopyrrolate reduced the total dose of ephedrine required and the severity of hypotension during spinal anesthesia.
Why the study?
Hypotension and bradycardia are common complications during spinal anesthesia, prompting evaluation of the maternal hemodynamic effects of prophylactic glycopyrrolate during elective caesarean section.
Does prophylactic intravenous glycopyrrolate improve maternal hemodynamics and reduce vasopressor requirement in pregnant women undergoing spinal anesthesia for elective caesarean section?
RCT (n=82)
Sealed envelope method
No
Does prophylactic intravenous glycopyrrolate improve maternal hemodynamics and reduce vasopressor requirement in pregnant women undergoing spinal anesthesia for elective caesarean section?
Prophylactic intravenous glycopyrrolate reduces the severity of hypotension and the need for ephedrine during spinal anesthesia for elective caesarean section, though it increases the incidence of dry mouth.
Answers are grounded in this paper and cite their sources.
Prophylactic glycopyrrolate may reduce hypotension and vasopressor needs without preventing bradycardia in spinal caesarean anesthesia; leaves open confirmation in larger trials.
Introduction: Hypotension and bradycardia are the most common complications during spinal anesthesia. Bradycardia decreases cardiac output, resulting in hypotension and even cardiac arrest. Glycopyrronium, an anticholinergic drug increases heart rate and prevents bradycardia during spinal anesthesia by blocking the effects of acetylcholine on the sinoatrial node. The study aims to measure the maternal hemodynamic effect of glycopyrrolate after spinal anesthesia for elective caesarean section. Method: An intervention, comparative study was conducted in Patan Hospital after approval from Ethical Committee. Eighty-two pregnant women scheduled for elective caesarean section were randomly assigned in two groups by sealed envelope method; Group I received glycopyrrolate 0.2mg intravenous, Group II did not receive glycopyrrolate. The patient’s heart rate, blood pressure, mean arterial pressure, a total dose of ephedrine, the occurrence of nausea, vomiting, and dry mouth were recorded. Independent-T test, chi-square test were used for statistical analysis. Result: Among 82 elective caesarean sections, 41 in each group, Group II (non-glycopyrrolate) reported increased heart rate compared to Group I (glycopyrrolate), but was statistically not significant. The highest recorded diastolic blood pressure was more in Group I compared to Group II and was statistically significant. The highest recorded Mean Arterial Pressure was high in the glycopyrrolate group and was statistically significant. The total dose of ephedrine was lower in the statistically significant glycopyrrolate group. The incidence of dry mouth was more in the glycopyrrolate group and the difference was statistically significant. Conclusion: Glycopyrrolate reduces the incidence of hypotension but not bradycardia and decreases the need for vasopressor.
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Piya et al. (2021) conducted an RCT in Elective caesarean section under spinal anesthesia (n=82). Glycopyrrolate vs. Normal saline was evaluated on Total dose of ephedrine required (mg) (p=0.02). Prophylactic intravenous glycopyrrolate reduced the total dose of ephedrine required and the severity of hypotension during spinal anesthesia.
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