Evaluation of Hypotensive Prevention Effect of Intramuscular Glycopyrrolate in Spinal Anesthesia of Elderly TURP Patients: A Randomized Control Trial

Objective: Spinal anesthesia is one of the options for transurethral resection of the prostate (TURP) patients. However, due to patient old age, risk factors, and the procedure itself, hemodynamic instability is common and hazardous. Glycopyrrolate, an anticholinergic drug, has been used in many indications, including in hypotensive prevention in cesarean section patients undergoing spinal anesthesia. The study aims to evaluate the hypotensive prevention effect of the drug in elderly (>60 years) spinal anesthesia TURP patients. Methods: Prospective randomized control trial of 62 elderly who indicated to TURP from December 2019 to January 2020. American Society of anaesthesiologists (ASA) classification of more than three, glycopyrrolate's contra-indication and unable to take spinal anesthesia, were exclusion criteria. 0.2 milligram (mg) intramuscular glycopyrrolate 15 minutes before spinal anesthesia was the primary testing process. Data were collected concurrently with hemodynamic parameters, which were recorded as a baseline and every five munites up to 60 minutes. The analysis was done with both single and repeated measure analysis. Results: Hypotensive incidence was significantly less in the glycopyrrolate group(38.7 vs. 74.2%). Intravenous fluid and vasopressor requirements were also lower. All hemodynamic parameters were higher in the treatment group, except heart rate, which was not different among the groups. Conclusion: Intra-muscular glycopyrrolate could prevent spinal anesthesia-related hypotension without a difference in heart rate in elderly TURP patients in our data