Chest
Volume 136, Issue 2, August 2009, Pages 347-354
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Original Research
Interventional Pulmonology
Anticholinergic Premedication for Flexible Bronchoscopy: A Randomized, Double-Blind, Placebo-Controlled Study of Atropine and Glycopyrrolate

https://doi.org/10.1378/chest.08-2924Get rights and content

Background

Anticholinergic premedication is commonly used during flexible bronchoscopy, although the benefits are unproven and potential risks exist.

Methods

We studied 1,000 patients undergoing diagnostic flexible bronchoscopy to investigate the efficacy and safety of atropine and glycopyrrolate. Patients received atropine (0.01 mg/kg; n = 339), glycopyrrolate (0.005 mg/kg; n = 336), or placebo (2 mL of normal saline solution; n = 325) IM before bronchoscopy in a randomized, double-blind fashion. Bronchoscopist- and patient-reported secretions, cough and patient discomfort, oxygen desaturation, procedure time, and procedure-related adverse events were compared among the groups.

Results

After adjusting for covariates, glycopyrrolate (p = 0.02), but not atropine (p = 0.064), was associated with reduced bronchoscopist-reported airway secretions. Neither drug was independently associated with patient-reported airway secretions or with bronchoscopist- or patient-reported cough or discomfort. Neither drug was independently associated with oxygen desaturation. Atropine was associated with a longer procedure time (p = 0.042). Rise in heart rate and BP was significantly greater with anticholinergics, particularly atropine, compared with placebo.

Conclusions

Anticholinergic premedication may reduce airway secretions during flexible bronchoscopy but is not associated with any significant reduction in cough, patient discomfort, oxygen desaturation, or procedure time and is associated with greater hemodynamic fluctuations. Routine anticholinergic premedication may be unnecessary or even harmful during flexible bronchoscopy.

Section snippets

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)

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