Glycopyrrolate to Prevent Spinal Anesthesia Induced Hypotension in Pregnant-Women Who Underwent Cesarean Section: Randomized Controlled Trial

Abstract

Objective: A primary outcome was to compare an incidence of hypotension following an administration of glycopyrrolate versus a placebo before commencing a spinal anesthesia in pregnant-women. Simultaneously, a bradycardia prevention, an amount of ephedrine and atropine-resuscitated drugs, nausea-vomiting and dry lips of pregnant women and an APGAR score of neonates were secondary outcomes.

Method: This study was a double blinded randomized controlled trial in a 18-40 years of pregnant-women, who underwent the spinal anesthesia for an elective cesarean section during April 2018 to July 2019. Ninety-eight participants were randomized into two groups. The pregnant women were received the intravenous glycopyrrolate or normal saline before the spinal anesthesia. Blood pressure and heart rate were recorded in every 2 minutes for 10 minutes and following by every 5 minutes until 30 minutes after the spinal anesthesia. Furthermore, the severity of nausea-vomiting, dry lips of pregnant women and APGAR scores of neonates were recorded.

Results: The incidence of hypotension within 30 minutes after the spinal anesthesia in the glycopyrrolate group was significantly lower than the placebo group by 25 percent (IRR = 0.75) (p-value=0.032, 95%CI: 0.57 to 0.98). In addition, reduction of using ephedrine was significantly found in the glycopyrrolate group compared to the placebo group.

Conclusion: The intravenous glycopyrrolate could prevent the spinal anesthesia-induced hypotension in the pregnant-women who underwent the cesarean section, which was clinical useful in the future.