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Reducing spinal hypotension during caesarean delivery with glycopyrrolate: a meta-analysis
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Reducing Spinal Hypotension During Elective Caesarean Delivery with Glycopyrrolate
- a meta-analysis
SD Patel1, AS Habib2, S Sodha1, B Carvalho3, P Sultan1

1University College London Hospital , 2Duke University School of Medicine, 3Stanford University School of Medicine



Hypotension is a common and important complication associated with spinal anaesthesia for caesarean delivery (1). The objective of this meta-analysis was to determine if prophylactic glycopyrrolate administration reduces the hypotensive changes associated with spinal anaesthesia.



A literature search (Medline, Embase, CINAHL, Scopus and Pubmed) was performed to identify randomised controlled trials (RCTs) investigating the effect of glycopyrrolate on spinal-induced hypotension for elective caesarean delivery. Primary outcomes were incidence of hypotension and dose of vasopressor used (ephedrine equivalent). Secondary outcomes included: incidence of bradycardia, maximal heart rate (HR), incidence of nausea and vomiting and incidence of dry mouth. Risk ratios (RR)and mean differences (MD) were calculated using random effects modelling with 95% confidence interval.



Five RCTs met our inclusion criteria. A total of 311 patients were recruited in all study groups: 153 patients in the glycopyrrolate group and 158 in the control group. The incidence of spinal-induced hypotension was no different with prophylactic glycopyrrolate administration compared to placebo controls (RR 0.93 [0.71, 1.21]; p=0.59), but the dose of ephedrine required to treat hypotension was significantly reduced in the glycopyrrolategroup (MD -5.3 mg [-8.80 mg, -1.79 mg]; p=0.003). The glycopyrrolate group had a lower incidence of bradycardia (RR 0.15 [0.03, 0.80]; p=0.03), and the maximal HR achieved was significantly higher compared to the control group (MD 15.85 [7.90, 23.81]; p<0.0001). The incidences of nausea and vomiting, and dry mouth were similar between both groups with RR 0.81 [0.40, 1.63]; p=0.55 and RR 1.56 [0.10, 23.24]; p=0.75 respectively.



•Prophylactic glycopyrrolate administration for elective caesarean delivery does not affect the incidence of spinal-induced hypotension.
•It does result in a modest reduction in vasopressor requirements and incidence of bradycardia.
•Utilising glycopyrrolate for caesarean delivery under spinal anaesthesia should be considered.
•Larger, adequately powered studies investigating side-effects are still needed before routine gycopyrrolate use can be recommended for elective caesarean delivery. 


1.Stewart A, Fernando R, McDonald S, Hignett R, Jones T, Columb M. The dose-dependent effects of phenylephrine for elective cesarean delivery under spinal anesthesia. Anesth Analg 2010; 111: 1230 - 1237.


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