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The Effect of Glycopyrrolate on the Incidence of Hypotension and Vasopressor Requirement During Spinal Anesthesia for Cesarean Delivery: A Meta-analysis.

Publication ,  Journal Article
Patel, SD; Habib, AS; Phillips, S; Carvalho, B; Sultan, P
Published in: Anesth Analg
February 2018

BACKGROUND: The objective of this meta-analysis was to determine the efficacy of glycopyrrolate at reducing spinal hypotension during cesarean delivery. METHODS: A literature search was performed to identify randomized controlled trials investigating the effect of glycopyrrolate on spinal-induced hypotension during cesarean delivery. Primary outcomes were intraoperative hypotension and vasopressor requirement (phenylephrine equivalents). Secondary outcomes included heart rate (HR), nausea and vomiting, dry mouth, and Apgar scores. Risk ratios (RRs), and mean differences (MDs) were calculated using random-effects modeling with 95% confidence intervals for primary outcomes and 99% confidence intervals for secondary outcomes. RESULTS: Five randomized controlled trials met our inclusion criteria. A total of 311 patients were included: 153 received glycopyrrolate and 158 placebo. The incidence of spinal-induced hypotension was no different with prophylactic glycopyrrolate compared to control (RR, 0.93 [0.71-1.21]; P = .59), but the total phenylephrine dose required was significantly reduced with glycopyrrolate (MD, -62.64 μg [-107.61 to -17.66 μg]; P = .006). The maximal HR achieved in the glycopyrrolate group was significantly higher compared to controls (MD, 15.85 bpm [5.40-26.31]; P < .0001); however, the incidence of bradycardia was not statistically different. The incidence of intraoperative nausea and vomiting was not different between groups; however, glycopyrrolate increased the risk of dry mouth (RR, 5.15 [1.82-14.57]; P < .0001). Apgar scores at 1 and 5 minutes did not differ between groups. CONCLUSIONS: Prophylactic glycopyrrolate does not reduce the incidence of spinal-induced hypotension but results in a modest reduction in vasopressor requirements while increasing maternal HR.

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Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 2018

Volume

126

Issue

2

Start / End Page

552 / 558

Location

United States

Related Subject Headings

  • Vasoconstrictor Agents
  • Treatment Outcome
  • Randomized Controlled Trials as Topic
  • Pregnancy
  • Incidence
  • Hypotension
  • Humans
  • Glycopyrrolate
  • Female
  • Cesarean Section
 

Citation

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Patel, S. D., Habib, A. S., Phillips, S., Carvalho, B., & Sultan, P. (2018). The Effect of Glycopyrrolate on the Incidence of Hypotension and Vasopressor Requirement During Spinal Anesthesia for Cesarean Delivery: A Meta-analysis. Anesth Analg, 126(2), 552–558. https://doi.org/10.1213/ANE.0000000000002274
Patel, Selina D., Ashraf S. Habib, Sioned Phillips, Brendan Carvalho, and Pervez Sultan. “The Effect of Glycopyrrolate on the Incidence of Hypotension and Vasopressor Requirement During Spinal Anesthesia for Cesarean Delivery: A Meta-analysis.Anesth Analg 126, no. 2 (February 2018): 552–58. https://doi.org/10.1213/ANE.0000000000002274.
Patel, Selina D., et al. “The Effect of Glycopyrrolate on the Incidence of Hypotension and Vasopressor Requirement During Spinal Anesthesia for Cesarean Delivery: A Meta-analysis.Anesth Analg, vol. 126, no. 2, Feb. 2018, pp. 552–58. Pubmed, doi:10.1213/ANE.0000000000002274.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

February 2018

Volume

126

Issue

2

Start / End Page

552 / 558

Location

United States

Related Subject Headings

  • Vasoconstrictor Agents
  • Treatment Outcome
  • Randomized Controlled Trials as Topic
  • Pregnancy
  • Incidence
  • Hypotension
  • Humans
  • Glycopyrrolate
  • Female
  • Cesarean Section