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Abstract
Objective: To compare the effect of prophylactic glycopyrrolate on the incidence of hypotension and vasopressor requirement during spinal anesthesia for cesarean delivery.
Methods: This randomized controlled trial was conducted at the Department of Anesthesia, Civil Hospital, Karachi. A total of 212 parturients were included and randomly allocated into two groups of 106 each. Patients in the glycopyrrolate group received 0.2 mg intravenous glycopyrrolate, whereas patients in the placebo group received 1 ml of 0.9% normal saline before initiation of phenylephrine infusion. All patients received standardized spinal anesthesia using hyperbaric bupivacaine with fentanyl, crystalloid co-loading, and phenylephrine infusion titrated to maintain systolic blood pressure within 20% of baseline. The primary outcome was the incidence of hypotension. Secondary outcomes included maternal bradycardia, maternal tachycardia, and total intraoperative phenylephrine requirement.
Results: Hypotension occurred in 33 (31.1%) patients in the glycopyrrolate group compared with 43 (40.6%) in the placebo group (p=0.13). Maternal bradycardia was significantly less frequent with glycopyrrolate than placebo (5.7% vs. 14.2%; p=0.04). Maternal tachycardia occurred in 69 (65.1%) and 59 (55.7%) patients, respectively (p=0.16). The mean phenylephrine requirement was 1098.6 ± 276.4 μg in the glycopyrrolate group and 1171.8 ± 291.7 μg in the placebo group (p=0.07).
Conclusion: Prophylactic glycopyrrolate was associated with a lower incidence of maternal bradycardia during spinal anesthesia for cesarean delivery. Although hypotension and phenylephrine requirements were numerically lower with glycopyrrolate, these differences were not statistically significant.