Which preoperative drug may prevent bradyarrhythmias caused by pneumoperitoneum, albeit with the side effect of dry mouth?

Which preoperative drug may prevent bradyarrhythmias caused by pneumoperitoneum, albeit with the side effect of dry mouth?

• A. H2 blocker
• B. Benzo
• C. Glycopyrrolate
• D. Atropine (correct)

Answer: (D)

Pneumoperitoneum during laparoscopy can provoke a vagal reflex that slows the heart. An antimuscarinic given before anesthesia blocks acetylcholine at cardiac muscarinic receptors, preventing this bradycardic response. Atropine is a rapid-acting muscarinic antagonist that quickly neutralizes the vagal input, thus reducing the risk of bradyarrhythmias when the abdomen is insufflated. The trade-off is dry mouth, a common anticholinergic side effect due to reduced salivation. While other antimuscarinics like glycopyrrolate can also prevent bradycardia, atropine is the classic, fast-acting choice for this preoperative prophylaxis.

Pneumoperitoneum during laparoscopy can provoke a vagal reflex that slows the heart. An antimuscarinic given before anesthesia blocks acetylcholine at cardiac muscarinic receptors, preventing this bradycardic response. Atropine is a rapid-acting muscarinic antagonist that quickly neutralizes the vagal input, thus reducing the risk of bradyarrhythmias when the abdomen is insufflated. The trade-off is dry mouth, a common anticholinergic side effect due to reduced salivation. While other antimuscarinics like glycopyrrolate can also prevent bradycardia, atropine is the classic, fast-acting choice for this preoperative prophylaxis.