Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate.
Author(s): Malik JA, Gupta D, Agarwal AN, Jindal SK
Affiliation(s): Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences Medical College, Srinagar, India. email@example.com
Publication date & source: 2009-08, Chest., 136(2):347-54. Epub 2009 Mar 24.
Publication type: Comparative Study; Randomized Controlled Trial
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.