USE OF GLYCOPYRROLATE TO TREAT INTRAOPERATIVE PENILE ERECTION - CASE-REPORT AND REVIEW OF THE LITERATURE

Background and Objectives. Penile erections following the initiation o f either axial regional or general anesthesia is rare; however, when i t occurs in patients undergoing urologic procedures it may delay, or e ven cancel, the planned surgery. The purpose of this case report and r eview is to enhance anesthesiologists' understanding of this phenomeno n so that they may better formulate a logical treatment scheme in such an event. Methods. We present a case of intraoperative erection after the initiation of continuous spinal anesthesia that was treated with intravenous glycopyrrolate. From the literature, 72 references were re viewed. Results. Glycopyrrolate successfully treated intraoperative pe nile erection. The physiology and pharmacology of erection are reviewe d, and pharmacologic treatment options and surgical treatments are rev iewed. Conclusions. In patients with coronary artery disease, or in si tuations where cardiovascular stability is desired, glycopyrrolate is an effective means of relieving intraoperative penile erections. Other pharmacologic interventions, based on the physiology of erections, ar e presented. Nitric oxide, a potent smooth muscle relaxant, has been s hown to be involved in the initiation and maintenance of erections; fu ture research involving specific inhibitors of this chemical is indica ted for the possible treatment of intraoperative penile erections.