[Efficacy of glycopyrronium bromide and scopolamine hydrobromide in patients with death rattle: a randomized controlled study].
BACKGROUND
Death rattle is an extremely distressing symptom for the dying patient and for his environment. The aim of this study was to assess the efficacy of glycopyrronium bromide as compared with scopolamine hydrobromide in alleviating death rattle in terminal cancer patients with cognitive impairment.


METHODS
In a randomized, controlled study design patients were allocated in two groups. Group A received scopolamine hydrobromide in a dose of 0.5 mg intravenously every 6 hours for a period of 12 hours, group B received glycopyrronium bromide 0.4 mg every 6 hours for a period of 12 hours. In addition, standardized sedatives were administered as required and the analgesic therapy continued either orally or, if necessary, subcutaneously or intravenously in equipotent doses. Every 2 hours death rattle was assessed and rated on a scale of 1 to 5 (1 = audible breathing noises, 5 = very severe rattling noises). In addition, restlessness and expressions of pain were assessed and rated on a scale of 1 to 3 (1 = mild, 2 = moderate, 3 = severe).


RESULTS
13 patients were included in the study, 7 patients were allocated to group A and 6 patients to group B. There were no significant differences in demographic data, age, weight and diagnosis distribution between the two groups. Group B demonstrated a significant reduction of death rattle in the first 12 hours (p = 0.029) in comparison to group A. There were no significant differences concerning the side effects (restlessness, expressions of pain) in both groups.


CONCLUSIONS
Glycopyrronium bromide given in a dose of 0,4 mg every six hours demonstrated a significant reduction of death rattle compared to scopolamine hydrobromide. Concerning side effects (restlessness, expressions of pain) there was no difference between both substances.
Likar
Rudolf
R
Schmerzklinik, Abteilung für Anästhesie und Intensivmedizin, LKH Klagenfurt, Austria. Rudolf.likar@kabeg.at
Rupacher
Ernst
E
Kager
Hans
H
Molnar
Mario
M
Pipam
Wofgang
W
Sittl
Reinhard
R
D000368:Aged; D012634:Bodily Secretions / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D006024:Glycopyrrolate / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage; D010276:Parasympatholytics / Q000008:administration & dosage; D010865:Pilot Projects; D015990:Placebo Effect; D012135:Respiratory Sounds / Q000187:drug effects*; D012601:Scopolamine / Q000008:administration & dosage*; D013727:Terminal Care / Q000379:methods; D016896:Treatment Outcome
D018727:Muscarinic Antagonists; D010276:Parasympatholytics; D012601:Scopolamine; D006024:Glycopyrrolate