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Glycopyrrolate-Neostigmine and Atropine-Neostigmine Mixtures Affect Postanesthetic Arousal Times Differently

Anis Baraka, MD^*, Jean-Pierre Yared, MD, Anne-Marie Karam, MD, and Alon Winnie, MD

*Professor and Chairman, Department of Anesthesiology, American University of Beirut, Beirut, Lebanon. Third Year Resident, Department of Anesthesiology, American University of Beirut, Beirut, Lebanon. Assistant Professor, Department of Anesthesiology, American University of Beirut, Beirut, Lebanon. Professor and Chairman, Department of Anesthesiology, University of Illinois, Chicago, Illinois.

Abstract

Atropine-neostigmine and glycopyrrolate-neostigmine mixtures used in 54 premedicated patients for reversal of non-depoiarizing neuromuscular blockade were compared for their effects on postanesthetic arousal times. Anesthesia was induced in all patients with thiopental and was maintained with N2O-O2. Atropine-neostigmine significantly delayed arousal for the first 30 minutes following cessation of anesthesia and reversal of neuromuscular blockade. The difference between the two mixtures following reversal of neuromuscular blockade is attributed to the fact that atropine is a tertiary amine that crosses the blood-brain barrier and delays arousal, whereas glycopyrrolate is a quaternary ammonium compound that does not cross this barrier.

Key Words: PARASYMPATHETIC NERVOUS SYSTEM: glycopyrrolate and atropine • NEUROMUSCULAR RELAXANTS: reversal • RECOVERY: glycopyrrolate and atropine.