ROLE OF INTRAMUSCULAR GLYCOPYRROLATE IN PREVENTING HYPOTENSION AFTER SUBARACHNOID BLOCK IN ELDERLY PATIENTS

Abstract

Post-subarachnoid block (SAB) hypotension presents itself as a major challenge in the perioperative setting of elderly patients because there is an evolution in cardiovascular alterations and disorders related to age. Glycopyrrolate, a manmade medicine that has anticholinergic effects, may reduce the bradycardia and vasodilation caused by SAB because of its vagolytic actions, thereby possibly preventing hypotension. The study was a randomized, double-blind, placebo-controlled trial that also evaluated the effect of intramuscular glycopyrrolate in alleviating hypotension among patients 70 years old and up who underwent surgery in the lower limbs under SAB. Ninety patients between the ages of 65-85 years were randomly allocated to either receive glycopyrrolate 0.2 mg intramuscularly 15 minutes before SAB (Group G, n=45), or equivalent volume saline (Group S, n=45). The hemodynamics were noted at baseline; following the SAB introduction of 0.5% combined bupivacaine at L3-L4, blood pressure and the rate of heartbeat were observed. Hypotension was characterized by the decrease in MAP by >25 of baseline values or a systolic BP <90 mmHg. In the event of hypotension, mephentermine it was administered Group G experienced far fewer events of hypotension (13% vs. 42%, p<0.01), and less vasopressor (3 +/ -1 mg vs. 8 +/- 2 mg, p<0.001) was used and maintained better hemodynamics. There was no observed adverse anticholinergic effects The IM active glycopyrrolate seems to be safe and effective in the reduction of hypotension in the aged patients during SAB.

Keywords: Glycopyrrolate, hypotension, subarachnoid block, elderly, vasopressor