Role of intramuscular glycopyrrolate in preventing hypotension after subarachnoid block in elderly patients

Abstract

Background Hypotension is one of the most frequent complications during spinal anaesthesia. It is more common in elderly with a reported incidence of 65–75%. While keeping in mind that the hypotension induced by subarachnoid block is related to sympathetic blockade accompanied with bradycardia, the administration of glycopyrrolate could affect hemodynamic during spinal anaesthesia. Thus, we aimed at evaluating the role of intramuscular glycopyrrolate in preventing hypotension after subarachnoid block in elderly patients.Patients and methods It’s a randomized double blind study. Forty four patients (60–80 years of age, ASA I and II) posted for lower abdominal surgery or lower limb surgery were given subarachnoid block using standard anaesthesia technique. They were administered either 1 ml of normal saline (group N) or 0.2 mg glycopyrrolate (group G) intramuscularly 15 minutes before subarachnoid block. Parameters like blood pressure and heart rate (at preset time intervals), total requirement of ephedrine, time to first rescue vasopressor i.e. ephedrine, incidence of nausea and vomiting and requirement of Ondansetron, incidence of bradycardia and requirement of atropine, presence of dry mouth etc was recorded.Results Eleven of 22 (50%) patients in group N experienced hypotension compared with two of 22(9.09%) patients in group G (difference=40.91% ; P=0.001). The mean ephedrine requirement in group G is 0.45±1.47 mg while, in group N is 3.63±4.41 mg (P=0.001). There was no case of bradycardia reported in group G although, two out of 22 patients (9.09%) in group N reported bradycardia (P=0.55). There is no incidence of nausea and vomiting in group G while, 3 patients in group N complained about nausea and vomiting (P=0.03).Conclusion The intramuscular administration of 0.2 mg glycopyrrolate in elderly patients undergoing subarachnoid block significantly reduces the incidence and degree of hypotension; and reduces the total consumption of rescue vasopressor without any clinically significant side effect.