| Background and Objective:Currently preoperative application of anticholinergic drugs is mainly atropine, and the main purpose of anticholinergic drugs application is to inhibit the gland secretion, however, atropine non-selectively antagonizes M cholinergic receptor, which often brings about faster heart rate, urinary retention and intestinal paralysis and other side effects. Penehyclidine hydrochloride as a new anticholinergic drug can selectively act on the M1, M3 and N1, N2 subtype receptors, but has no effect on the M2 subtype receptor, so that normal neurotransmitter regulation is maintained, and it effectively avoids the common adverse reactions such as increased heart rate, excessive postoperative urinary retention and intestinal paralysis caused by anticholinergic drugs. What's more, it has a longer efficacy time and stronger inhibitory effect on glandular secretion than atropine. Through comparison the effects of penehyclidine hydrochloride and atropine as premedication on gastric cancer patients undergoing radical gastrectomy, we recorded the first postoperative flatus and utilized radioimmunoassay method to detect the levels of plasma motilin, all in all, our ultimately purpose is to choose rational premedication anticholinergic drugs.Methods:A total of 56 ASA physical status I and II patients undergoing radical gastrectomy surgery were enrolled in this study, which aged 30 to70 years and from July 2009 to February 2010, and were randomized divided into penehyclidine hydrochloride group (group P) and atropine group (group A) under double-blind trial. Written, informed consent was received from patients. Patients with a history of cardiovascular diseases, respiratory, endocrine or glaucoma, or any other systemic diseases were excluded from the study. 4 cases in group P and 2 cases in group A were bradycardia, the heart rates was less than 50 times, the six patients were used atropine, they were also excluded from the study. All patients were fasted 8 hours before operation. Cardiac rate, Non-invasive Blood Pressure, SP02, ETCO2, were monitored with Philips Monitor when the patients entered the operating room. 50 patients were assigned to atropine and penehyclidine hydrochloride group, 25 patients in each group. Either 0.5 mg atropine or 0.5 mg penehyclidine hydrochloride was given by deep intramuscular injection at right deltoid 30 minutes before operation. Anaesthesia was induced in the two teams equally with midazolam 0.06 mg/kg, fentanyl 4μg/kg, cisatracuronium 0.15 mg/kg, etomidate 0.03 mg/kg. Laryngoscopy and tracheal intubation with an appropriate sized cuffed tube was performed when fasciculations had ceased and muscle relaxation occurred. Sustained propofol, remifentanil and discontinuous cisatracuronium were used for the further maintenances of anesthesia. All patients were sent to recovery room. The first postoperative flatus were recorded, the plasma levels of motilin (MTL) was measured by radioimmunoassay (RIA) at 12 (T1) hours before and 24 (T2), 48 (T3) hours after the operation.Results:The time that the first postoperative flatus in the penehyclidine hydrochloride group was exhausted (85.09±10.02 h) was earlier than that in the atropine group (93.64±13.09 h) (P<0.05), which is statistical significance. No significant difference in MTL levels was found at preoperatively 12 (T1) hours between the two groups. The plasma MTL levels of the patients in the penehyclidine hydrochloride group were significantly higher than that in the atropine group (P< 0.05) at 24 (T2), 48 (T3) hours after the operation. The MTL levels in the two groups at postoperatively 24 (T2), 48 (T3) hours were significantly lower than that at preoperative 12 (T1) hours.Conclusion:Application penehyclidine hydrochloride as premedication is better than atropine, for the first postoperative anal exhaust time in the penehyclidine hydrochloride group was earlier than that in the atropine group, indicating that penehyclidine hydrochloride as premedication is more conducive to the recovery of gastrointestinal function than the most commonly used drugs atropine. The postoperative motilin levels in the penehyclidine hydrochloride group was higher than that in the atropine group, indicating that penehyclidine hydrochloride can help the recovery of gastrointestinal function for the motilin has a promoting effect on gastrointestinal motility.
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