The role of anticholinergics in bronchoscopy. A randomized clinical trial.
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.


METHODS
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.


METHODS
A large academic teaching hospital in the midwestern United States.


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


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.


CONCLUSIONS
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.
Cowl
C T
CT
Division of Pulmonary, Critical Care, and Internal Medicine, Mayo Medical School and Mayo Medical Center, Rochester, MN, USA. cowl.clayton@mayo.edu
Prakash
U B
UB
Kruger
B R
BR
D000368:Aged; D001285:Atropine / Q000627:therapeutic use*; D001999:Bronchoscopy; D004311:Double-Blind Method; D005260:Female; D006024:Glycopyrrolate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010147:Pain Measurement; D011292:Premedication; D011446:Prospective Studies
D018727:Muscarinic Antagonists; D001285:Atropine; D006024:Glycopyrrolate