Chest
Volume 118, Issue 1, July 2000, Pages 188-192
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Bronchoscopy
The Role of Anticholinergics in Bronchoscopy: A Randomized Clinical Trial

https://doi.org/10.1378/chest.118.1.188Get rights and content

Background

Anticholinergic medications have been utilized frequently prior to bronchoscopy and are thought to facilitate the drying of secretions to limit the amount of required topical anesthetic on the airway mucosa, prevent cardiac arrhythmias during the procedure, and increase patient comfort.

Objective

To determine if atropine or glycopyrrolate, two anticholinergic agents utilized most frequently in this setting, have any significant role for this purpose.

Design

Double-blind, placebo-controlled study, in which patients were randomly selected to receive atropine (0.01 mg/kg body weight, IM injection), glycopyrrolate (0.005 mg/kg, IM injection), or saline solution placebo (approximately 2 mL, IM injection) 15 to 45 min prior to being sedated with midazolam until judged to be lightly sedated.

Setting

A large academic teaching hospital in the midwestern United States.

Participants

Two hundred seventeen outpatients referred for bronchoscopy who satisfied inclusion and exclusion criteria.

Measurements and results

Using a modified visual analog scale (0 to 100 mm), the bronchoscopist and the nurse anesthetist estimated the antisialagogic effect, effectiveness in cough suppression, and overall patient comfort during the procedure. The patients completed a similar questionnaire after recovering from the procedure. Patients were also monitored for complications (cardiac arrhythmias, oxygen desaturation, hypertension, wheezing, or coughing severe enough to curtail the procedure). There was no significant difference found among atropine, glycopyrrolate, and placebo for the primary end point of secretion control. In addition, there was no difference found between either medication and placebo for effectiveness of cough suppression, amount of topical anesthetic used, complication rates, or overall patient comfort.

Conclusion

The use of anticholinergic agents prior to bronchoscopy did not affect performance of bronchoscopy or complication rates, and there was no appreciable benefit from the resultant reduction in airway secretions in a population of patients receiving concurrent sedation with benzodiazepines.

Section snippets

Materials and Methods

A total of 217 patients undergoing elective outpatient fiberoptic bronchoscopy participated in this prospective, placebo-controlled, double-blind study after providing informed written consent and after approval by the Institutional Review Board for ethical research. Patients were randomly assigned to receive atropine, 0.01 mg/kg body weight; glycopyrrolate, 0.005 mg/kg; or saline solution placebo, approximately 2 mL. All agents were administered IM, 15 to 45 min prior to the procedure.

Study

Results

The characteristics of each patient group were similar in terms of age and gender (Table 1). Equivalent doses of medications were utilized, and there was no appreciable difference in the time required to complete the bronchoscopy for each subgroup of patients. Indications for bronchoscopy and procedures performed during bronchoscopy are given in Table 2.

Five bronchoscopies (2.3% of the total) required early termination of the procedure: atropine (n = 2), glycopyrrolate (n = 1), and placebo (n =

Discussion

The use of anticholinergic agents to prevent reflex bronchoconstriction and bradycardia, reduce secretions, and minimize cough has been commonly employed by bronchoscopists throughout North America.1 As with all IM medication delivery, the use of these agents adds a certain amount of patient discomfort, a small but present overall risk, and, when summed over many patients, a significant increase in cost. Unfortunately, studies designed to examine the safety and efficacy of these drugs are

ACKNOWLEDGMENT

We wish to thank the nurses of the Mayo Medical Center, Department of Surgical Services, for their assistance in administering the patient visual analog surveys. We also wish to acknowledge Darrell R. Schroeder, Mayo Medical Center, Department of Health Sciences Research, for assistance with statistical analysis.

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    Supported by a clinical trial grant from Glaxo Wellcome, Research Triangle Park, NC.

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