Users Online: 678 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 

RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to [email protected] preferably by 30th June 2019.


Table of Contents
Year : 2020  |  Volume : 36  |  Issue : 3  |  Page : 424-425

Combined dexmedetomidine and glycopyrrolate infusion: Have we found our solution?

1 Department of Anesthesiology and Critical care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
2 Department of Anesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission20-May-2020
Date of Acceptance21-May-2020
Date of Web Publication16-Oct-2020

Correspondence Address:
Dr. Mritunjay Kumar
Department of Anaesthesiology, Pain medicine and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joacp.JOACP_276_20

Rights and Permissions

How to cite this article:
Bansal R, Kumar M, Makam H. Combined dexmedetomidine and glycopyrrolate infusion: Have we found our solution?. J Anaesthesiol Clin Pharmacol 2020;36:424-5

How to cite this URL:
Bansal R, Kumar M, Makam H. Combined dexmedetomidine and glycopyrrolate infusion: Have we found our solution?. J Anaesthesiol Clin Pharmacol [serial online] 2020 [cited 2021 Mar 3];36:424-5. Available from:

Dear Editor,

Sedation is frequently given to the patients undergoing surgery under regional anaesthesia to mitigate physical and psychological discomfort. Dexmedetomidine, a highly selective α2 agonist sedative, anxiolytic, analgesic, muscle relaxant, with minimal respiratory depression, and with sympatholytic properties is one of the preferred choices. But one has to be cautious, for it has serious cardiovascular side effects including bradycardia and hypotension, which is very commonly observed. We report use of glycopyrrolate infusion to counter hemodynamic side effects dexmedetomidine in a 62-year obese male undergoing open reduction and internal fixation surgery for the fracture of acetabulum and tibia under a combined spinal and epidural block.

The patient was prone for bradycardia with dexmedetomidine infusion and at the same time anxious and also had history of snoring. So, we decided to add 200 μg each of dexmedetomidine and glycopyrrolate with normal saline, to get the final concentration 4 μg/mL of both dexmedetomidine and glycopyrrolate in a single syringe.

Infusion was started with a bolus of 1 μg/kg for 10 min and maintained at 0.5 μg/kg/min for 2 h. Ramsay Sedation Scale was maintained between 3 and 4 while the heart rate was within normal limits throughout the duration. The highest recorded heart rate was 70 per min. Blood pressure fluctuations were within 10% of baseline. The surgery was uneventful and no adverse events were noted postoperatively.

Although pretreatment with anticholinergics has been tried earlier, [1,2] this is the first attempt at using it as infusion. As it is only a single case report, well-designed trials are needed to validate the concept of the simultaneous use of glycopyrrolate and dexmedetomidine and also to establish the optimum dose/regimen.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Subramanyam R, Cudilo EM, Hossain MM, McAuliffe J, Wu J, Patino M,et al. To pretreat or not to pretreat: Prophylactic anticholinergic administration before dexmedetomidinein pediatricimaging. Anesth Analg 2015;121:479-85.  Back to cited text no. 1
Available from: [Last accessed on 2020 Sep 24].  Back to cited text no. 2


    Similar in PUBMED
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded61    
    Comments [Add]    

Recommend this journal