The Effect Of Glycopyrrolate Combined With Neostigmine On Hemodynamics In Patients With Hyperhemoglobin

Objective:The hemodynamic effects of glycopyrrolate and atropine combined with neostigmine in patients with hyperhemoglobin during antagonizing the residual effects of the muscle relaxants in the recovery period of general anesthesia.At the same time,the time of extubation,saliva secretion and cognitive function score 24 hours after operation were compared between the two groups.Methods:Sixty patients with hyperhemoglobin undergoing elective general anesthesia and non-cardiac surgery were randomly divided into glycopyrrolate group(n = 30)and atropine group(n = 30).The recovery period of general anesthesia after the operation.When the train of four stimulation(TOF)recovered to 0.1,according to the preset scheme,glycopyrrolate 0.008 mg/kg and neostigmine 0.04mg/kg was injected intravenously in the glycopyrrolate group or atropine 0.02 mg and neostigmine0.04mg/kg was injected intravenously in the atropine group.At the same time,the changes of hemodynamics(heart rate,systolic blood pressure,diastolic blood pressure and mean arterial pressure)were observed and recorded before administration(T0)and at 1 minutes(T1),3 minutes(T2),5 minutes(T3),10 minutes(T4),20 minutes(T5)and30 minutes(T6)after administration.The time of extubation,saliva secretion,cognitive function 24 hours after operation by MMSE score and adverse reactions after administration were evaluated.Results:1.Heart rate: compared with T0 time,the heart rate in atropine group increased significantly at T1,T2 and T3 after administration(P < 0.05),and the heart rate at T5 and T6 was lower than that at T0(P < 0.05).The heart rate in theglycopyrrolate group changed little after administration,and the increase of heart rate in the T1,T2 and T3 atropine group was higher than that in the glycopyrrolate group(P < 0.05).2.Blood pressure: compared with T0 time,the systolic blood pressure,diastolic blood pressure and mean arterial pressure at T1,T2,T3 and T4 in atropine group were significantly higher than those at T0(P < 0.05).The systolic blood pressure,diastolic blood pressure and mean arterial pressure at T3,T4 and T5 in the glycopyrrolate group were higher than those in the T0 group(P < 0.05).The blood pressure at T1 and T2 in the atropine group was significantly higher than that in the glycopyrrolate group.3.There was no significant difference in saliva secretion between the two groups(P > 0.05).The extubation time in the glycopyrrolate group was shorter than that in the atropine group(P < 0.05).The effect of cognitive function at 24 hours after operation in the glycopyrrolate group was less than that in the atropine group(P < 0.05).Three patients in the atropine group developed bradycardia(heart rate < 50 bpm),and one patient in the glycopyrrolate group developed bradycardia and all of them were treated with atropine.There was no significant difference in the incidence of adverse reactions of bradycardia between the two groups(P > 0.05).Conclusions:Glycopyrrolate combined with neostigmine can be safely used to antagonize residual muscle relaxation during general anesthesia in patients with hyperhemoglobin,and can significantly reduce the hemodynamic fluctuation compared with atropine combined with neostigmine.