THE INFLUENCE OF PREMEDICATION WITH GLYCOPYRROLATE FOR SPINAL ANAESTHESIA IN PREGNANT WOMEN UNDERGOING ELECTIVE CAESAREAN SECTION
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Keywords
Glycopyrrolate, Spinal Anaesthesia Caesarean Sections.
Abstract
BACKGROUND
Haemodynamic changes such as hypotension and bradycardia remain common complications associated with spinal anaesthesia in the obstetric population. If left untreated, spinal-induced hypotension and bradycardia can have detrimental effects for both mother and fetus, including maternal cardiovascular collapse and fetal acidosis. The use of glycopyrrolate for reducing haemodynamic changes after spinal anaesthesia for cesarean delivery has been investigated in multiple studies, which have shown conflicting results.
METHODS
This was a prospective observer-blinded, comparative study carried out over a period of 18 months involving 60 parturients. The study subjects were randomly allocated into 2 equal groups by simple random sampling using the shuffled closed sealed envelope technique, namely Group G & C. Group G received intravenous glycopyrrolate 0.2 mg (1 ml), while Group C received intravenous normal saline 1 ml. 0.5% hyperbaric bupivacaine was used for spinal anesthesia in both groups. Hemodynamic and block characteristics were recorded for each of the groups.
RESULTS
There was a statistically significant difference in mean pulse rate from 8 minutes to 20 minutes and at 30 minutes between the normal saline and glycopyrrolate groups (p < 0.05%). Higher SBP, DBP, and MAP were seen 3 minutes and 5 minutes after induction of spinal anesthesia in the glycopyrrolate group (p<0.05). There was a statistically significant (p<0.05) difference in the total ephedrine used between the two groups. There was no significant difference in the incidence of intraoperative nausea, vomiting, and PONV. There was a significant difference in dryness of mouth in distribution between the two groups, being higher in the glycopyrrolate group (p = 0.019).
CONCLUSION
Pre-treatment with 0.2 mg of glycopyrrolate before administering spinal anaesthesia in pregnant women posted for elective caesarean sections decreases the incidence of hypotension before the extraction of the neonate. Glycopyrrolate also reduces the incidence of bradycardia and decreases the requirement of vasopressor, without any incidence of serious adverse side effects.
References
[2] Ngan Kee WD. Prevention of maternal hypotension after regional anaesthesia for caesarean section. Curr Opin Anaesthesiol 2010;23:304-9.
[3] Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg 2010;111:1230-7.
[4] Shen CL, Ho YY, Hung YC, Chen PL. Arrhythmias during spinal anesthesia for cesarean section. Can J Anesth 2000;47:393-7.
[5] Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006;(4):CD002251.
[6] Ali-Melkkilä T, Kanto J, Iisalo E. Pharmacokinetics and related pharmacodynamics of anticholinergic drugs. Acta Anaesthesiol Scand 1993;37:633-42.
[7] Shen CL, Ho YY, Hung YC, Chen PL. Arrhythmias during spinal anesthesia for cesarean section. Can J Anesth 2000;47:393-7.
[8] Ure D, James KS, Mcneill M, Booth JV. Glycopyrrolate reduces nausea during spinal anaesthesia for Caesarean section without affecting neonatal outcome. Br J Anaesth 1999;82(2):277-9.
[9] Biswas BN, Rudra A, Das SK, Nath S, Biswas SC. A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post-operative nausea and vomiting after spinal anaesthesia for caesarean delivery. Indian J Anaesth 2003;47(3):198-200.
[10] Quiney NF, Murphy PG. The effect of pretreatment with glycopyrrolate on emetic and hypotensive problems during caesarean section conducted under spinal anaesthesia. Int J Obstet Anesth 1995;4:66-7.
[11] Rucklidge MWM, Durbridge J, Barnes PK, Yentis SM. Glycopyrronium and hypotension following combined spinal-epidural anaesthesia for elective Caesarean section in women with relative bradycardia. Anaesthesia 2002;57:4-8.
[12] Yentis SM, Jenkins CS, Lucas DN, Barnes PK. The effect of prophylactic glycopyrrolate on maternal haemodynamics following spinal anaesthesia for elective caesarean section. Int J Obstet Anesth 2000;9:156-9.
[13] Chamchad D, Horrow JC, Nakhamchik L, Sauter J, Roberts N, Aronzon B, et al. Prophylactic glycopyrrolate prevents bradycardia after spinal anesthesia for cesarean section: a randomized, double-blinded, placebo-controlled prospective trial with heart rate variability correlation. J Clin Anesth 2011;23:361-6.
[14] Jain R, Sharma R. A comparative study of effects of glycopyrrolate and ondansetron on nausea and vomiting in caesarean section under spinal anesthesia. Anesth Essays Res 2015;9:348-52.
[15] Yoon HJ, Cho HJ, Lee IH, Jee YS, Kim SM. Comparison of hemodynamic changes between phenylephrine and combined phenylephrine and glycopyrrolate groups after spinal anesthesia for cesarean delivery. Korean J Anesthesiol 2012;62:35-9.
[16] Patel SD, Habib AS, Sioned Phillips S, Carvalho B, Sultan P. The effect of glycopyrrolate on the incidence of hypotension and vasopressor requirement during spinal anesthesia for cesarean delivery: a meta-analysis. Anesth Analg 2018;126:552-8.
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Dr. Varshini Visweswara
Senior Registrar, Department Anaesthesiology, Manipal Hospital, Miller's Road, Bangalore, Karnataka, India.
Dr. Darshini S.
Assistant Professor, Department Anaesthesiology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India.
Dr. Vyshnavi S.
Associate Professor, Department Anaesthesiology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India.
Dr. Ashwini N.
Assistant Professor, Department Anaesthesiology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India.
Dr. Girish B.K.
Associate Professor, Department Anaesthesiology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India.
Dr. Ashwini A.
Consultant Intensivist, Department of Critical Care Medicine, JSS Hospital, Mysore, Karnataka, India.