Chest
Original ResearchInterventional PulmonologyAnticholinergic Premedication for Flexible Bronchoscopy: A Randomized, Double-Blind, Placebo-Controlled Study of Atropine and Glycopyrrolate
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Patients
A total of 1,000 consecutive patients undergoing elective bronchoscopy from January 2003 to May 2004 were included. All inpatients and outpatients > 15 years of age were eligible. Patients who had previously participated in any similar study, patients undergoing brachytherapy or therapeutic bronchoscopy for removal of secretions, patients with a history of glaucoma or prostatic disorders, patients with < 90% baseline oxygen saturation on finger pulse oximetry, patients using oxygen
Results
Bronchoscopy was successfully conducted in all the patients. A total of 339 patients received atropine, 336 received glycopyrrolate, and 325 received placebo. Table 1 shows the characteristics of patients in the three treatment groups. Lung cancer was the most common indication for performing bronchoscopy. The nasotracheal approach was used for the procedure in approximately 95% of the patients.
The scores (by both the bronchoscopist and patient) for airway secretions, cough, and discomfort were
Discussion
The principal findings of the present study are that anticholinergic premedication may reduce airway secretions during bronchoscopy but not cough, patient discomfort, oxygen desaturation, or procedure time. Further, anticholinergic premedication is associated with greater hemodynamic fluctuations compared with placebo.
To the best of our knowledge, this is the largest study to investigate the utility and safety of anticholinergic premedication for bronchoscopy. Previous smaller studies about
Acknowledgments
Author contributions: All the authors contributed in the conception and design of the study. Drs. Malik, Gupta, and Agarwal were involved in collection of the data, monitoring data safety, and final analysis of the data. All the authors were involved in interpretation of the findings and writing and revising the manuscript.
Financial/nonfinancial disclosures: The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or
References (0)
Cited by (39)
Sedation in Bronchoscopy: A Review
2018, Clinics in Chest MedicineCitation Excerpt :In fact, Cowl and colleagues54 found no significant benefit in reduced secretions, patient comfort, or cough frequency. A randomized, double blind, placebo-controlled trial by Malik and colleagues55 reported decreased secretions, without significant reduction in cough, discomfort, desaturations or procedure time. Conversely, greater hemodynamic instability was noted after anticholinergic administration when compared with placebo.23,55
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2014, Journal of Emergency MedicineCitation Excerpt :It exhibits cardiovascular stability and maintains protective airway reflexes and can be used to facilitate airway evaluations or awake intubations. Bronchorrhea may be attentuated with a drying agent such as glycopyrrolate or atropine (27). In patients with severe hemodynamic compromise, the dose should be reduced to 1 mg/kg.
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2012, British Journal of AnaesthesiaCitation Excerpt :In the present study, no anticholinergic agent was administered as a premedication or antisialagogue. Anticholinergic agents have been associated with haemodynamic disturbances such as tachycardia and hypertension.22 In addition, previous studies have not demonstrated the beneficial effect of anticholinergic premedication on airway secretion, coughing, and patient discomfort during flexible bronchoscopy.22 26
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