Prevention of glycopyrrolate against bradycardia induced by neostigmine: a multicenter, randomized, double-blind, doubledummy, parallel-controlled clinical trial

Objective To compare the efficacy and safety of glycopyrrolate versus atropine against bradycardia induced by neostigmine. Methods Patients scheduled for elective non-cardiac surgery were central randomly assigned to experimental group(n=123) and control group (n=124). Patients in experimental group were administered with glycopyrrolate at a dose of 0.008 mg/kg and neostigmine 0.04 mg/kg in 1 minute, whereas patients in control group received atropine at a dose of 0.016 mg/kg and neostigmine 0.04 mg/kg in 1 min to antagonize the remained neuromuscular block effect at the end of operation, respectively. Heart rate was recorded for 15 min after administration of the antagonized mixture, the area under the time curve(AUC) of the difference between heart rate and baseline heart rate, heart rate per minute and the difference between heart rate and baseline heart rate were compared. The dose of atropine for rescue therapy after administration was also recorded. Also, the adverse events within 24 h after operation were followed and compared. Results The AUC of the difference between heart rate and baseline heart rate was smaller in experimental group than the AUC in control group (P 0.05). Conclusions The effects of glycopyrrolate and atropine on preventing bradycardia when given in a mixture with neostigmine for the reversal of non-depolarizing neuromuscular block were compared. Glycopyrrolate has better effect than atropine for maintaining heart rate stability. Key words: Glycopyrrolate; Atropine; Neostigmine; Bradycardia