Document Detail


The effects of reversal of neuromuscular blockade on autonomic control in the perioperative period.
MedLine Citation:
PMID:  8989016     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Impaired parasympathetic control of heart rate is associated with increased incidence of cardiac dysrhythmias and ischemia. Anticholinergic drugs suppress parasympathetic control and could be detrimental in the early postoperative period in high-risk patients. In this double-blind randomized trial, 30 ASA physical status I and II patients undergoing minor surgery received either atropine 20 micrograms/kg and neostigmine 50 micrograms/kg (Group A), glycopyrrolate 8 micrograms/kg and neostigmine 50 micrograms/kg (Group G), or placebo (Group P) for reversal of neuromuscular blockade. Two indices of parasympathetic modulation of heart rate, spontaneous baroreflex sensitivity, and high-frequency heart rate variability, were assessed. At 2 h after reversal, Group A showed persisting impairment of baroreflex sensitivity with respect to Group P (7.12 +/- 0.86 vs 12.71 +/- 1.38 ms/mm Hg, P = 0.022) as well as decreased high-frequency heart rate variability (280.8 +/- 30.1 vs 569.2 +/- 115.2 ms2/Hz, P = 0.015). Groups A and G showed a borderline decrease in normalized high-frequency variability at 2 h (P = 0.05 for Groups A and G versus Group P). Anticholinergic drugs with neostigmine cause impairment of parasympathetic control of heart rate which persists into the early postoperative period. The effects of glycopyrrolate appear to be of shorter duration; this drug may thus be preferable in patients at risk of cardiovascular complications.
Authors:
J M van Vlymen; J L Parlow
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  84     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-01-29     Completed Date:  1997-01-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  148-54     Citation Subset:  AIM; IM    
Affiliation:
Department of Anaesthesia, Queen's University, Kingston, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Atropine / administration & dosage*,  pharmacology
Autonomic Nervous System / drug effects*,  physiology
Baroreflex / drug effects,  physiology
Double-Blind Method
Female
Glycopyrrolate / administration & dosage*,  pharmacology
Heart / innervation
Heart Rate / drug effects,  physiology
Humans
Male
Middle Aged
Muscarinic Antagonists / administration & dosage*,  pharmacology
Neostigmine / administration & dosage*,  pharmacology
Neuromuscular Blockade*
Parasympathomimetics / administration & dosage,  pharmacology
Postoperative Period
Chemical
Reg. No./Substance:
0/Muscarinic Antagonists; 0/Parasympathomimetics; 51-55-8/Atropine; 59-99-4/Neostigmine; 596-51-0/Glycopyrrolate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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