During laparoscopic surgery, the surgeon requests a drug to reduce intraoperative bronchospasm triggered by tracheal intubation. The patient has benign prostatic hyperplasia and narrow-angle glaucoma. Which muscarinic antagonist is SAFEST in this setting?
- A Atropine intravenously
- B Scopolamine transdermally
- C Ipratropium via inhalation ✓
- D Glycopyrrolate intravenously
Correct answer: C. Ipratropium via inhalation
Explanation
Ipratropium via inhalation exerts its bronchodilatory effect locally in the airways with minimal systemic absorption, avoiding the risks of acute urinary retention (BPH) and precipitation of acute angle-closure glaucoma that systemic anticholinergics carry. Atropine, scopolamine, and glycopyrrolate given systemically can worsen urinary retention in BPH and precipitate acute angle-closure glaucoma. Glycopyrrolate, while quaternary and less CNS-penetrant, still carries systemic anticholinergic risks that are contraindicated here.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.