Comparison of atropine and glycopyrronium in patients with pre‐existing cardiac disease

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Abstract
Summary: The effects of atropine and glycopyrronium, when given intravenously with neostigmine during the reversal of neuromuscular blockade in patients with cardiovascular disease, were compared in a double blind trial. Atropine was associated with a significantly greater elevation of heart rate and rate‐pressure product than glycopyrronium. This elevation was also more sustained with atropine. The entire atropine population also showed a significantly greater incidence of ST‐segment depression on the electrocardiogram than that observed in those who had received glycopyrronium. Furthermore, patients with ischaemic heart disease and previous myocardial infarction who received atropine showed a significantly greater incidence of dysrhythmias than those given glycopyrronium. It is suggested that at the time of reversal of neuromuscular blockade in patients with cardiovascular disease, glycopyrronium is a more suitable agent than atropine.