Comparison of glucagon and scopolamine butylbromide as premedication for colonoscopy in unsedated patients.
OBJECTIVE
Premedication with glucagon or hyoscyamine is reported to be effective in reducing colonic spasm. However, these drugs can be associated with unfavorable events. This prospective study was designed to compare the effects of premedication with glucagon with those of scopolamine butylbromide on cardiopulmonary parameters, intubation time, and patient discomfort in unsedated patients undergoing diagnostic colonoscopy.


METHODS
One hundred consecutive adult patients (65 males) undergoing colonoscopy without sedation were randomized to receive 1 mg of glucagon (n = 50) or 20 mg of scopolamine butylbromide (n = 50), intramuscularly. Physiologic changes, including systolic blood pressure, heart rate, and oxygen saturation, were monitored before colonoscope insertion and at three-minute intervals during colonoscopy. The percentages of completed procedure and time to cecal intubation were recorded. Patients were asked to rate pain by using a five-point pain score (0 = no pain; 4 = severe pain).


RESULTS
The percentages of completed procedure (96 vs. 98 percent), time to cecal intubation (16.3 vs. 14.5 minutes), and pain score (1.7 vs. 1.5) did not differ significantly between two groups. An increase in heart rate of more than ten beats per minute from baseline during colonoscopy occurred significantly more often in scopolamine group (44 percent of 50 patients) than in the glucagon group (12 percent of 50 patients; P = 0.0004). There were no significant differences between the two study groups with regard to changes in systolic blood pressure and decrease in oxygen saturation during colonoscopy.


CONCLUSIONS
Premedication with 1 mg of glucagon facilitates favorable examination with respect to physiologic changes compared with 20 mg of scopolamine. These features favor glucagon as the preferred premedication for patients undergoing colonoscopy.
Yoshikawa
Ichiro
I
Third Department of Internal Medicine, University of Occupational and Environmental Health Japan, School of Medicine, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
Yamasaki
Masahiro
M
Taguchi
Masashi
M
Kanda
Kikuo
K
Tashiro
Mitsuo
M
Kume
Keiichiro
K
Tabaru
Akinari
A
Otsuki
Makoto
M
D000368:Aged; D002086:Butylscopolammonium Bromide / Q000008:administration & dosage*; D003108:Colonic Diseases / Q000517:prevention & control*; D003113:Colonoscopy / Q000009:adverse effects; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005934:Glucagon / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage*; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D010276:Parasympatholytics / Q000008:administration & dosage*; D011292:Premedication; D013035:Spasm / Q000517:prevention & control*
D005765:Gastrointestinal Agents; D018727:Muscarinic Antagonists; D010276:Parasympatholytics; D002086:Butylscopolammonium Bromide; D005934:Glucagon; D010100:Oxygen