Glycopyrrolate is frequently administered in combination with neostigmine to reverse a neuromus- cular blockade. The dosage was well established at 1/5 of neostigmine. But the authers have often observed a delayed manifestation of relative bradycardia after such a recommended dosage. This is not mentioned in the literature, but this may be due to an insufficient observation period. The authors monitored the change of pulse rate for 1 hour after the administration of the recom. mended dose. Further, the data wIns compared with that obtained after studies of lower and higher doses. The doses were 0.004, 0.008 and 0.012mg/kg of glycopyrrolate with 0.04mg/kg of neostigmine. 1) At all doses, bradycardia relative to the pre-reversal pulse rate was progressive until 30 minutes after injection. 2) As the glycopyrrate dose was increased the degree of bradycardia decreased (-24.7, -20.5, - 15.0 at 30 min.). 3) There was no difference in the immediate change in the pulse rate between the dcsages of 0.008 and 0.012 mg/kg. Change occured at 9 mins. 4) At dosages of 0.004 and 0.008 mg/kg, the pulse rates at 60 min were comparable to their ward pulses, but at a dosage of 0.012 mg/kg, the pulse rate was 8.5 beats/min higher.
Bradycardia ; Glycopyrrolate* ; Heart Rate* ; Neostigmine*

No abstract available.
Glycopyrrolate* ; Salivary Glands* ; Scopolamine Hydrobromide*

BACKGROUND: Sugammadex is a novel neuromuscular reversal agent, but its associated hypersensitivity reaction and high cost have been obstacles to its widespread use. In the interest of reducing the necessary dosage of sugammadex, the reversal time of the combined use of sugammadex and neostigmine from moderate neuromuscular blockade were investigated. METHODS: The patients enrolled ranged in age from 18 to 65 years old with American Society of Anesthesiologists class 1 or 2. The subjects were randomly assigned into one of the four groups (Group S2, S1, SN, and N; n = 30 per group). The reversal agents of each groups were as follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1 mg/kg + neostigmine 50 microg/kg + glycopyrrolate 10 microg/kg, N - neostigmine 50 microg/kg + glycopyrrolate 10 microg/kg. The time to recovery of the train-of-four (TOF) ratio was checked in each group. RESULTS: The time to 90% recovery of TOF ratio was 182.6 +/- 88.9, 371.1 +/- 210.4, 204.3 +/- 103.2, 953.2 +/- 379.7 sec in group S2, S1, SN and N, respectively. Group SN showed a significantly shorter recovery time than did group S1 and N (P < 0.001). However, statistically significant differences between the S2 and SN groups were not be observed (P = 0.291). No hypersensitivity reactions occurred in all groups. CONCLUSIONS: For the reversal from rocuronium-induced moderate neuromuscular blockade, the combined use of sugammadex and neostigmine may be helpful to decrease the recovery time and can also reduce the required dosage of sugammadex. However, the increased incidence of systemic muscarinic side effects must be considered.
Glycopyrrolate ; Humans ; Hypersensitivity ; Incidence ; Neostigmine* ; Neuromuscular Blockade*

BACKGROUND: The primary outcome of sugammadex reversal for rocuronium-induced neuromuscular block (NMB) is a train-of-four ratio (TOFR) of 0.9, not first twitch (T1) height. We investigated whether the recovery of TOFR or T1 differs based on the reversal of NMB with neostigmine or sugammadex. METHODS: The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in 80 patients after induction of anesthesia. The TOFR and T1 height were recorded, and saved in a personal computer using TOF-Watch SX Monitor software in all patients. Patients were randomly assigned to 2 groups to receive either neostigmine 50 µg/kg with glycopyrrolate 10 µg/kg (neostigmine group, n = 40) or sugammadex 2.0 mg/kg (sugammadex group, n = 40). The primary objective was to determine the difference of recovery time between TOFR to 0.9 and T1 to 0.9 after sugammadex or neostigmine administration during moderate rocuronium-induced NMB. RESULTS: The recovery pattern of the TOFR 2 min after sugammadex administration was 1.0 or more, but that of T1 was less than 90% (T1 / control value) up to 6 min after drug was injected. The recovery pattern of TOFR and T1 was similar during the 20 min after reversal with neostigmine. CONCLUSIONS: If you have not performed the T1 monitoring, both TOFR and T1 should be considered to confirm suitable recovery during the 6 min after reversal with sugammadex during rocuronium-induced moderate NMB.
Anesthesia ; Depression* ; Glycopyrrolate ; Humans ; Microcomputers ; Neostigmine ; Neuromuscular Blockade* ; Neuromuscular Monitoring

Fourty pediatric patients anesthetized with halothane-nitrous oxide-oxygen, who received pancronium for the maintenance of muscular relaxation, were divided into two groups. On anesthesia, in group l, atropine(20ug/kg) and neostigmin(40ug/kg), and in group ll, glycopyrrolate(10ug/kg) and neostigmine(40ug/kg) were injected transvenously. The changes in heart rate and arrythmis were then observed. The results were as follows: 1) The safety and effectiveness of both groups in antagonizing the muscarinic actions of neostigmine were demonstrated. 2) Glycopyrrolate produced a significantly smaller change in heart rate than atropine. 3) In both groups, arrhythmis could not be observed.
Anesthesia ; Atropine* ; Glycopyrrolate* ; Heart Rate* ; Heart* ; Humans ; Neostigmine* ; Relaxation

The effect of preanesthetic administration of glycopyrrolate and cimetidine on gastric fluid pH and volume were studied. Forty patients scheduled for elective surgery were fandomly placed into two groups. Patients in group 1 were given glycopyrrolate intramuscularly (0.003 mg/kg) 30-60 minutes before induction of anesthesia, while group 2 patients received glycopyrrolate intramuscularly and 200mg of cimetidine intravenouly 2 hours before induction of anesthesia. Nasogastric tubes were placed and gastric pH and volume were measured. The results showed that patients in group 1 hade a medn gastric pH of 2.428+/-1.378. Twenty five percent of these patients had gastric contents with a pH of 2.428+/-1.378. Twenty five percent of these patients had gastric contents with a pH above 2.5 and a volume greater than 25ml. In contrast, group 2 patients had a mean gastric pH of 5.566+/-1.969, 85 percent had a ph above 2.5 and 15 percent had a volume greater than 25ml. These findings demonstrate that cimetidine markedly increases gastric pH. The authors recoment that patients reciving general anesthesia be given cimetidine preoperatively.
Anesthesia ; Anesthesia, General ; Cimetidine* ; Glycopyrrolate ; Humans ; Hydrogen-Ion Concentration*

BACKGROUND: After sinus surgery, airway dryness is made worse because patients breathe by mouth. Anticholinergic agents have antisialogogue effects. The airway dryness that occurs after surgery is severe and can increase the incidence of postoperative sore throat. MATERIALS AND METHODS: One-hundered patients who were scheduled for endoscopic sinus surgery(ESS) were divided into four groups. Each group was premedicated with glycopyrrolate or had no premedication and reversed with glycopyrrolate or atropine. After the surgery the patients were asked about a sore throat and hoarseness postoperatively after 1h, 6h, 12h, 24h, and 48hours, respectively. RESULTS: The incidence of postoperative sore throat and hoarseness was not significantly different among the four groups at any time. CONCLUSION: The severity of complications after ESS was low and subsided within 24 hours. Therefore, the use of anticholinergic agents does not need to be limited.
Atropine ; Cholinergic Antagonists* ; Glycopyrrolate ; Hoarseness ; Humans ; Incidence ; Mouth ; Pharyngitis* ; Premedication

BACKGROUND: Rapid and complete reversal of neuromuscular blockade (NMB) is desirable at the end of surgery. Sugammadex reverses rocuronium-induced NMB by encapsulation. It is well tolerated in Caucasian patients, providing rapid reversal of moderate (reappearance of T2) rocuronium-induced NMB. We investigated the efficacy and safety of sugammadex versus neostigmine in Korean patients. METHODS: This randomized, safety assessor-blinded trial (NCT01050543) included Korean patients undergoing general anesthesia. Rocuronium 0.6 mg/kg was given prior to intubation with maintenance doses of 0.1-0.2 mg/kg as required. Patients received sugammadex 2.0 mg/kg or neostigmine 50 microg/kg with glycopyrrolate 10 microg/kg to reverse the NMB at the reappearance of T2, after the last rocuronium dose. The primary efficacy endpoint was the time from sugammadex or neostigmine administration to recovery of the train-of-four (TOF) ratio to 0.9. The safety of these medications was also assessed. RESULTS: Of 128 randomized patients, 118 had evaluable data (n = 59 in each group). The geometric mean (95% confidence interval) time to recovery of the TOF ratio to 0.9 was 1.8 (1.6, 2.0) minutes in the sugammadex group and 14.8 (12.4, 17.6) minutes in the neostigmine group (P < 0.0001). Sugammadex was generally well tolerated, with no evidence of residual or recurrence of NMB; four patients in the neostigmine group reported adverse events possibly indicative of inadequate NMB reversal. CONCLUSIONS: Sugammadex was well tolerated and provided rapid reversal of moderate rocuronium-induced NMB in Korean patients, with a recovery time 8.1 times faster than neostigmine. These results are consistent with those reported for Caucasian patients.
Anesthesia, General ; Glycopyrrolate ; Humans ; Intubation ; Neostigmine* ; Neuromuscular Blockade* ; Recurrence

When antagonism to neuromuscular block is needed, glycopyrrolate is the new anticholinergic drug emplyed to counteract the muscarinic action of neostigmine. To know the effect on heart rate after an injection of glycopyrrolate and neostigmine mixture, we observed the changes in heart rate after injection of the mixtures and changing the ratio of glycopyrrolate(0.2mg/vial) to neostigmine(0.5mg/smpul) using 2 to 1, 2 to 1.5, 1 to 1, 1.5 to 2 and 1 to 2 during halothane anesthesia. The result of this study showed that the heart rates were more stable in the group given the ratio of glycopyrrolate 1 vial(0.2mg) to neostigmine 1 ampule(0.5mg) than any other gorups.
Anesthesia ; Glycopyrrolate* ; Halothane ; Heart Rate* ; Heart* ; Neostigmine* ; Neuromuscular Blockade

Essential hyperhidrosis is a socially disabling and emotionally embarrassing condition. Localized excessive sweating in the sacrococcygeal region is a rare form of focal hyperhidrosis. Although numerous treatment options exist, including botulinum toxin and sympathetic neurolysis, there has been no generally accepted form of treatment. The following cases describe the successful reduction of excessive sweating in the sacrococcygeal region, without side effects, after local applications of topical glycopyrrolate and the use of fast drying clothes.
Botulinum Toxins ; Glycopyrrolate ; Hyperhidrosis* ; Sacrococcygeal Region* ; Sweat ; Sweating