Efficacy of Intravenous Glyco-P® in Patients Undergoing Procedure That Require Anesthesia Service

Background and rationale Glycopyrrolate has been long used since it's first discovery in 19602. The medication is generally available in both oral and injectable form. The uses of glycopyrrolate in anesthesia are mainly for reduction of salivation and secretion3, which plays significant role when airway instrumentation required. The widespread uses of neostigmine for reversal of muscle relaxant effects caused by non-depolarizing muscle relaxant also mandate the co-administration of anti-muscarinic4,5,6. Without availability of glycopyrrolate, atropine was used in Thailand, which results in excessive tachycardia and salivation7,8,9. Glycopyrrolate can also be used when mild bradycardia is encountered but the effects on heart rate is less dominant than atropine10,11.

Glycopyrrolate is considered an orphan drugs in Thailand. There was simply no availability until recently. The local company named "Masu" has decided to market and import the drug from India (Glyco-P®). The formulary has been approved by Thai Food and Drug Administration1. The preparation has also been tested in laboratory by third party well-known pharmacy institute, which proved the existence of an active ingredient. However, the uses of this medication officially have not been made and the appropriate action is to obtain IRB approval at local institution and consent the patients prior to drug administration. The appropriate record of clinical effect should also been made.

Objective

1. Evaluate the clinical efficacy of glycopyrrolate on heart rate, anti-sialagogue effects and when used in conjunction with neostigmine for reversal of neuromuscular blockade.
2. Evaluate the timing, onset and duration of glycopyrrolate injection at different dose.

Materials, participants and study method The study requires