Esophagus, Parasympatholytics, Glycopyrrolate

In the 1970s, the radial artery was proposed as a coronary artery bypass graft but then was abandoned due to graft occlusion secondary to spasm during harvesting. Development of new pharmacologic antispasmodic agents and minimal traumatic harvesting techniques has led to the revival of the use of the radial artery in coronary artery bypass procedures. Harmonic Scalpel(Ultracision Inc, Smithfield, RI) offers the surgeon the ability to perform less traumatic, spasm free, and rapid radial artery harvesting.
Coronary Artery Bypass ; Parasympatholytics ; Radial Artery* ; Spasm ; Transplants

OBJECTIVETo investigate the impact of intestinal spasmolytic on colon polyps and adenoma detection rate during colonoscopy.

METHODSLiteratures related to the effect of intestinal spasmolytic on colon polyp or adenoma detection rate were retrieved from PubMed, Medline, EBSCO, High Wire Press, OVID, EMBASE, and the China National Knowledge Articles, etc. published before July 2014. Unified data were extracted by two researchers independently and organized using Jadad scale to evaluate the quality of the enrolled studies through Review manager 5.2 Meta-analysis software.

RESULTSSix articles were enrolled with total 47,509 cases, including 16,867 cases in the scopolamine group and 30,642 cases in the placebo group. Meta analysis showed spasmolytic could increase the detective rate of polyps (OR=1.24, 95% CI:1.19-1.30), adenoma (OR=1.25, 95% CI:1.19-1.30) and high-risk adenoma (OR=1.22, 95% CI:1.16-1.29).

CONCLUSIONUsing colonoscopy spasmolytic scopolamine can increase the detection rate of colonic polyp and adenoma.

1. The antispasmodic effect of some official drugs were studied in dogs using balloons appropriately placed on the intact enteric tract. Intestinal contractions were kymographically recorded2. Comparable doses (threshold relaxing doses) of the pharmacologic agents were determined and tested under uniform experimental conditions3. Tested against spontaneous, Barium-stimulated and Pilocarpine-stimulated intestinal contractions, Methantheline and Atropine were shown to be the most potent agents. Aminophylline, Papaverine and Glyceryl trinitrate follow in the order named. This comparison is on the basis of the average duration of their respective inhibiting effect on the intestine4. The experimental findings in this method of study appear to be in close agreement with clinical observations5. It is postulated that in certain gastro-intestinal conditions characterized by hyperperistalsis, spasm and pain, these antispasmodics will prove clinically effective, if wisely administered. (Summary and Conclusions)
Parasympatholytics, Atropine, Methantheline, Aminophylline, Glyceryl Trinitrate, Barium, Pilocarpine, Antispasmodics

Background: Systemic absorption of topical phenylephrine administered during mydriasis may potentially cause hemodynamic changes in patients. Objective: To compare the hemodynamic outcomes between patients given tropicamide+phenylephrine and those given tropicamide alone for mydriasis. Design: Randomized controlled trial. Setting: Ophthalmology Outpatient Clinic, Southern Philippines Medical Center, Davao City, from April to June 2017. Participants: 56 male and female patients aged ≥ 19 years and scheduled for mydriasis. Interventions: Random allocation to either one drop of 0.5% tropicamide plus 0.5% phenylephrine or one drop of 0.5% tropicamide for mydriasis of the examined eye. Main outcome measures: Mean systolic BP, mean diastolic BP, mean arterial pressure, mean heart rate, and at least one episode of tachycardia or bradycardia. Main results: Thirty (53.57%) patients received tropicamide drops, and the rest received tropicamide+phenylephrine drops. The demographic and clinical characteristics of the two intervention groups were comparable at baseline. The mean blood pressures and heart rates at 15, 30, 45, and 60 minutes postmydriasis did not significantly differ between the two groups. Four patients from the tropicamide group, and none from the phenylephrine+tropicamide group had tachycardia (p=0.1153). On the other hand, five patients from the tropicamide group, and four from the phenylephrine+tropicamide group had bradycardia (p=1.0000). Conclusion Hemodynamic outcomes did not significantly differ up to 60 minutes after mydriasis between patients who received tropicamide+phenylephrine drops and those who received tropicamide drops.
Blood Pressure ; Heart Rate ; Sympathomimetics ; Muscarinic Antagonists ; Parasympatholytics

There are many reports about post-anesthetic nausea and vomiting. Pst-anesthetic nausea and vomiting can cause not only severe discomfort but also many complications. McKie (1970) said that the incidence varies from 23% 82%. But nowadays, the incidence seems greatly decreased due to the development of anesthetic techniques and anesthetic agents. We studied the incidence and factors affecting nausea and vomiting in 564 patients under general anesthesia from July 1, 1975. to September 30, 1975. at Severance Hospital, The conclusions are as follows; (1) The over all incidence is 34%. (2) It is more common in women. (3) It is less common below 10 years of age. (4) It is more common after prolonged anesthesia. (5) It is most common with ether. (6) It is more common when parasympatholytic agents are used for premedication. (7) It is most common in abdominal operations. We also studied post-anesthetic headache, and the incidence was 15%. Post-anesthetic headache was most common with halothane. There are many different opinions about the effect of the prophylactic use of antiemetics for post-anesthetic nausea and vomiting. So we studied the prophylactic antiemetic effect in ether anesthesia with the use of perphenazine HCI (Trimin). The antiemetic reduced the incidence from 42% to 3% in cases using ether.
Anesthesia ; Anesthesia, General* ; Anesthetics ; Antiemetics ; Ether ; Female ; Halothane ; Headache ; Humans ; Incidence ; Nausea* ; Parasympatholytics ; Perphenazine ; Premedication ; Vomiting*

PURPOSE: The aim of this study was to determine the effectiveness of the hot pack as a complementary technique for the treatment of nonspecific abdominal pain or acute gastroenteritis in a hospital emergency department. METHODS: This study was conducted as a prospective case-controlled trial of patients with nonspecific abdominal pain or acute gastroenteritis who visited an emergency department. A total of 166 participants, from 18 to 75 years old, were divided into two groups: patients treated with antispasmodics and hot pack (WH) group (n=83) and patients treated with antispasmodics without a hot pack (WOH) group (n=83). Patients rated their pain using the 10 cm numerical rating scale (NRS). Pain NRS was assessed four times: first on arrival and then at 1, 2, and 3 hours after treatment. The frequency of tramadol use and residence time was also assessed. RESULTS: The two groups did not significantly differ in age or gender distribution. The mean NRS score also did not significantly differ between the groups upon arrival (p=0.847). The NRS scores at 1 hour and 2 hours after treatment in the WH group were significantly lower than NRS scores in the WOH group (p<0.001). There was no significant difference, however in NRS scores after 3 hours for both groups (p=0.091). There was a significant difference in NRS scores between admission and after 1 hour (p=0.005) and a significant difference in NRS scores between 2 hours and 3 hours (p<0.001). The frequency of tramadol use significantly differed between groups (p<0.01) but there was no significant difference in residence time in each group. CONCLUSION: The hot pack is an effective complementary technique for reducing abdominal pain in the hospital emergency department.
Abdominal Pain* ; Case-Control Studies ; Emergencies* ; Gastroenteritis* ; Heating ; Humans ; Pain Management ; Parasympatholytics ; Prospective Studies ; Tramadol

BACKGROUND/AIMS: Cimetropium bromide has been used widely as a premedication for endoscopy; however, there are no subjective data pertaining to the effects of cimetropum bromide as a premedication. Thus, the current study was undertaken to compare the effects of cimetropum bromide with placebo as a premedication for esophagogastroduodenoscopy (EGD). METHODS: Two hundred ninety-nine consecutive outpatients who had undergone EGD were enrolled in this study. Thirty minutes before EGD, the patients were randomly given an intramuscular injection of cimetropium bromide (5 mg) or saline using a placebo-controlled, double-blind, randomized technique. Immediately after EGD, all the patients and endoscopists were requested to fill out the questionnaire form. RESULTS: One-hundred patients were injected with cimetropium bromide and 150 patients were injected with placebo. There was no statistically significant difference in the degree of residual gastric secretions, the peristaltic activity detected by endoscopists, and the comfort experienced by the patients in each study group. CONCLUSIONS: The intramuscular injection of cimetropium bromide (5 mg) as a premedication for EGD was not significantly superior to placebo, at least with respect to subjective parameters, in spite of its broad use.
Endoscopy, Digestive System ; Humans ; Injections, Intramuscular ; Outpatients ; Parasympatholytics ; Premedication ; Scopolamine Derivatives ; Surveys and Questionnaires

BACKGROUND: Ureteral colic due to acute obstruction of urine flow is a frequent and painful condition presenting in the emergency department. Proper control of ureteral colic is important in the management of such a patient. Many drugs, including narcotics, had been used to control ureteral colic, and of them, nonsteroidal anti-inflammatory drugs are most commonly used. This study was carried out to compare the analgesic effect of diclofenac with that of caroverine which is used empirically in ureteral colic. METHODS: We carried out a randomized, prospective clinical trial in the emergency department of a university hospital. Sixty patients in whom ureteral colic had been diagnosed on the basis of physical signs and symptoms were included in this study. Each patients received an IM dose of diclofenac 75 mg, a IV bolus dose of caroverine 20 mg, or a continuous infusion of caroverine 60 mg. An additional dose of medication was added 20 min after the initial medication if needed. RESULTS: The main outcome was measured by using both the visual analogue scale(VAS), four-point categorial pain scale at times of 20, 40, and 60 min after initial medication. The requirement for supplemental medication was also measured. At 40 min, diclofenac was more effective than the other two treatments according to its pain- relieving capacity(p<0.05) and the categorial pain scale. By 60 min, caroverine continuous infusion was less effective than the other two treatments according to visual analogue scale(VAS) and the categorial pain scale(p<0.05). There were no significant differences between the diclofenac group and the caroverine bolus injection group at this time. The diclofenac group needed significantly less rescue medication for pain control(p<0.05). CONCLUSION: IM diclofenac, a non-steroidal antiinflammatory drug, was superior to the spasmolytics, single bolus or continuous intravenous infused, in treatment of ureteral colic.
Diclofenac* ; Emergency Service, Hospital ; Humans ; Narcotics ; Parasympatholytics ; Prospective Studies ; Renal Colic* ; Ureter*

BACKGROUND/AIMS: We conducted a prospective, randomized, double-blinded, placebo-controlled trial to investigate the effect of hyoscine-N-butyl bromide during colonoscopy. METHODS: A total of 133 patients undergoing colonoscopy were randomized to receive either 20 mg of hyoscine-N-butyl bromide (n=70) or normal saline solution (n=63) via intramuscular injection as premedication. RESULTS: The mean cecal intubation time and withdrawal time in the hyoscine-N-butyl bromide group were significantly shorter than those of the control group (5.26+/-2.78 min vs. 6.74+/-4.89 min; p=0.032, 5.42+/-1.54 min vs. 6.18+/-2.54 min; p=0.038, each). The spasm grade in the hyoscine-N-butyl bromide group was significantly lower than that of the control group (p<0.001). No significant differences were found in the polyp detection rate (15.7% vs. 28.6%; p=0.073) and adenoma detection rate (10.0% vs. 15.9%; p=0.311). Difficulty of colonoscopy for the endoscopists and nurses (p=0.853; p=0.732), the patient's comfort (p=0.891) and the patient's willingness to repeat colonoscopy (85.7% vs. 82.5%; p=0.932) were also similar in both groups. CONCLUSIONS: Premedication with intramuscularly administered hyoscine-N-butyl bromide do not demonstrate any additional benefits except reducing the colonoscopy insertion time.
Adenoma ; Colonoscopy ; Humans ; Injections, Intramuscular ; Intubation ; Parasympatholytics ; Polyps ; Premedication ; Prospective Studies ; Scopolamine Hydrobromide ; Sodium Chloride ; Spasm