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.
determine if atropine or glycopyrrolate, two anticholinergic agents
utilized most frequently in this setting, have any significant role for
Design: 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.
Setting: A large
academic teaching hospital in the midwestern United States.
Participants: Two hundred seventeen outpatients referred
for bronchoscopy who satisfied inclusion and exclusion criteria.
Measurements and 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.
Conclusion: 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