Glycopyrrolate prophylaxis may not obviate Vasopressor need for hypotension in non-elective cesarean

A new trial found that glycopyrrolate prophylaxis for preventing hypotension could not reduce the necessity of vasopressor in the non-elective cesarean section under spinal anesthesia.

The trial results were published in the journal BMC Anesthesiology.  

Spinal Anesthesia is frequently used during cesareans, but hypotension may result following it which may adversely affect the neonate. As literature shows that glycopyrrolate increases maternal heart rate, researchers conducted a trial to determine if prophylactic use of glycopyrrolate decreases the vasopressor requirements to prevent hypotension following spinal anesthesia during non-elective cesarean section. 

A double-blind randomized clinical trial was done on 258 patients undergoing non-elective cesarean section. They were randomly assigned (1:1) to receive intravenous 0.2 mg glycopyrrolate or normal saline (placebo) before spinal anesthesia. The primary outcome was the phenylephrine equivalent needed intraoperatively. Secondary outcomes included incidences of maternal hypotension, reactive hypertension, bradycardia, need for atropine, tachycardia, intraoperative nausea/vomiting, shivering, pruritus, dry mouth, dizziness; neonatal APGAR score at 1 min and 5 min, neonatal resuscitation needed, NICU admission and neonatal death.

Results: 

255 participants were analyzed as 3 patients withdrew from the study due to failed spinal anesthesia.

The mean difference of phenylephrine equivalent between the two groups was 5.32 μg.

Hypotension and Tachycardia were reported in both groups. 

No statistically significant difference was noted in hypotensive episodes > 1, reactive hypertension, bradycardia, need for atropine, nausea, vomiting, shivering, and dry mouth between the two groups.

Neonatal outcomes were similar in the two groups. 

Thus, the necessity of a vasopressor to prevent hypotension could not be reduced by the prophylactic use of glycopyrrolate in the non-elective cesarean section under spinal anesthesia. 

Further reading: Deshar, R., Subedi, A., Pokharel, K. et al. Effect of glycopyrrolate on vasopressor requirements for non-elective cesarean section under spinal anesthesia: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 22, 327 (2022). https://doi.org/10.1186/s12871-022-01882-4