Abstract
Background
Hypothermia improves outcomes following ischemia-reperfusion injury. Shivering is
common and can be mediated by agents such as dexmedetomidine. The combination of dexmedetomidine
and hypothermia results in bradycardia. We hypothesized that glycopyrrolate would
prevent bradycardia during dexmedetomidine-mediated hypothermia.
Methods
We randomly assigned eight healthy subjects to premedication with a single 0.4 mg
glycopyrrolate intravenous (IV) bolus, titrated glycopyrrolate (0.01 mg IV every 3
min as needed for heart rate <50), or no glycopyrrolate during three separate sessions
of 3 h cooling. Following 1 mg/kg IV dexmedetomidine bolus, subjects received 20 ml/kg
IV 4 °C saline and surface cooling (EM COOLS, Weinerdorf, Austria). We titrated dexmedetomidine
infusion to suppress shivering but permit arousal to verbal stimuli. After 3 h of
cooling, we allowed subjects to passively rewarm. We compared heart rate, core temperature,
mean arterial blood pressure, perceived comfort and thermal sensation between groups
using Kruskal–Wallis test and ANOVA.
Results
Mean age was 27 (SD 6) years and most (N = 6, 75%) were male. Neither heart rate nor
core temperature differed between the groups during maintenance of hypothermia (p
> 0.05). Mean arterial blood pressure was higher in the glycopyrrolate bolus condition
(p < 0.048). Thermal sensation was higher in the control condition than the glycopyrrolate
bolus condition (p = 0.01). Bolus glycopyrrolate resulted in less discomfort than
titrated glycopyrrolate (p = 0.04).
Conclusions
Glycopyrrolate did not prevent the bradycardic response to hypothermia and dexmedetomidine.
Mean arterial blood pressure was higher in subjects receiving a bolus of glycopyrrolate
before induction of hypothermia. Bolus glycopyrrolate was associated with less intense
thermal sensation and less discomfort during cooling.
Keywords
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Article info
Publication history
Published online: June 01, 2021
Accepted:
May 23,
2021
Received in revised form:
May 14,
2021
Received:
November 6,
2020
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
