Comparative Observation Of Glycopyrronium Bromide Combined With Neostigmine In Reversal Of Neuromuscular Blockade Under General Anesthesia

Objective:To investigate the antagonistic effect of glycopyrronium bromide on neostramine adverse reactions and its influence on hemodynamics,and to compare it with atropine and penehyclidine hydrochloride,so as to optimize the postoperative antagonistic program of muscle relaxation-related residual complications,and to provide reference for clinical work.Methods:According to the inclusion criteria,60 patients undergoing laparoscopic general anesthesia in our hospital were selected and randomly included into 3 groups by random number table method,which were divided into atropine group（group A）,penehyclidine hydrochloride group（group B）and glycopyrronium bromide group（group C）,with 20 cases in each group.The patient abstained from food for 8h and water for 4h before anesthesia.No preoperative medication was used in all patients.Before the patient enters the room,prepare ephedrine,atropine and other related rescue drugs,and detect leaks in the anesthesia machine.After the patient entered the operating room,a tripartite check was performed,peripheral veins were routinely established,and vital signs of the patient were monitored,including electrocardiogram（ECG）,noninvasive blood pressure（Systolic blood Pressure,Diastolic blood pressure）,pulse（P）,heart rate（HR）,end-tidal carbon dioxide tension（Pet CO₂）,and bispect ral index（BIS）,pulse oxygen saturation（Sp O₂）,respiratory rate（RR）,baseline values were recorded.Anesthesia induction unified use:propofol2mg/kg,Sufentanil 0.4μg/kg,cisatracurium besylate 0.15mg/kg injection;anesthesia maintenancedrugs:reifentanil0.25～2μg/（kg·min）,propofol6～12mg/（kg·h）micropump,intermittent infusion of cis-atracurium as required by the operation,no more muscle relaxants expected 30min before the end of the operation,and inject muscle relaxant antagonists after spontaneous respiration:Group A:neostigmine 0.02mg/kg+atropine0.01mg/kg,GroupB:neostigmine0.02mg/kg+penehyclidinehydrochloride0.01mg/kg,group C:neostigmine0.02mg/kg+glycopyrronium bromide 0.005mg/kg.Observation indexes included:hemodynamic indexes（SBP,DBP,HR）at 1min before administration（T0）,1min after administration（T1）,5min after administration（T2）,10min after administration（T3）,15min after administration（T4）,and extubation time after muscle relaxation antagonism in 3 groups;age.Results:1.Compared with the T0 moment,there were no significant differences in SBP and DBP between the A,B and C groups at the T1～T4 moment（P>0.05）.2.The HR of patients in group A increased faster after administration,peaked at 5minutes,and showed a downward trend after 5 minutes,and the HR of group A was higher than that T0 at T1,T2 and T3,and the difference was statistically significant,among which,HR in T1 and T2 increased significantly compared with T0,and the difference was significant（P<0.01）;HR in group B increased after administration,peaked at T1 and was statistically significant compared with before administration（P<0.05）,while there was no statistical significance compared with T0 at other time points（P>0.05）.There was no significant difference in HR between T1～T4 and T0 in group C（P>0.05）.3.There was no significant difference in the time from muscle relaxation antagonism to catheter extraction between the three groups（P>0.05）.Conclusion:When the postoperative muscle is antagonistic,atropine,penehyclidine hydrochloride,and glycopyrronium bromide can safely and effectively resist the muscarinic reaction of neostigamine,and penehyclidine hydrochloride and glycopyrronium bromide have more stable heart rate characteristics than atropine.There was no difference in the effect of atropine,penehyclidine hydrochloride,glycopyrronium bromide use in combination with neostigmine on extubation time.There was also no difference in the effect on blood pressure.