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Midazolam Can Decrease Salivation During Bronchoscopy FREE TO VIEW

Seza Apiliogullari, MD; Jale Bengi Celik, MD; Ates Duman, MD
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From the Selcuklu Medical Faculty, Department of Anesthesia and Intensive Care, Selcuk University.

Correspondence to: Seza Apiliogullari, MD, Selcuklu Medical Faculty, Department of Anesthesia and Intensive Care, Selcuk University, 42075, Konya, Turkey; e-mail: sapiliogullari@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1277. doi:10.1378/chest.10-1237
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To the Editor:

We read with interest the response letter by Cowl1 (March 2010) to the study by Malik et al2 (August 2009) concerning the use of antisialogogues in broncoscopy. Based on the results of two previous studies, Cowl points out that antisecretory drugs do not result in clinically significant differences in cough or secretion control and can even be considered harmful.

We have a major concern about the designs of the studies by Malik et al2 and Cowl et al.3 In a recent randomized, double-blind, placebo-controlled, prospective, quantitative study,4 we demonstrated that midazolam decreases both unstimulated and stimulated saliva flow rates (from 0.31 g/min to 0.18 g/min and from 0.78 g/min to 0.31 g/min, respectively, P = .00). The study included 40 children aged 9 to 12. Unstimulated and paraffin-stimulated saliva was collected from each child at baseline and 10 min after midazolam injection. This antisialogogue effect of midazolam can be responsible for the barely statistically significant difference in visual analog scale scores between placebo and the anticholinergic drugs observed in the studies by Malik et al2 and Cowl et al.3 We are of the opinion that future studies should exclude midazolam from the design when the antisialogue effects of anticholinergic drugs are assessed.

Cowl CT. Use of antisialogogues in bronchoscopy. Chest. 2010;1373:738. [CrossRef] [PubMed]
 
Malik JA, Gupta D, Agarwal AN, Jindal SK. Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate. Chest. 2009;1362:347-354. [CrossRef] [PubMed]
 
Cowl CT, Prakash UBS, Kruger BR. The role of anticholinergics in bronchoscopy: a randomized clinical trial. Chest. 2000;1181:188-192. [CrossRef] [PubMed]
 
Apiliogullari S, Sener Y, Can S, Yegin Y, Tosun G, Celik JB. Effect of midazolam on salivary flow rate in children. J Selcuk U Dent Fac. 2010;192:3-7
 

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References

Cowl CT. Use of antisialogogues in bronchoscopy. Chest. 2010;1373:738. [CrossRef] [PubMed]
 
Malik JA, Gupta D, Agarwal AN, Jindal SK. Anticholinergic premedication for flexible bronchoscopy: a randomized, double-blind, placebo-controlled study of atropine and glycopyrrolate. Chest. 2009;1362:347-354. [CrossRef] [PubMed]
 
Cowl CT, Prakash UBS, Kruger BR. The role of anticholinergics in bronchoscopy: a randomized clinical trial. Chest. 2000;1181:188-192. [CrossRef] [PubMed]
 
Apiliogullari S, Sener Y, Can S, Yegin Y, Tosun G, Celik JB. Effect of midazolam on salivary flow rate in children. J Selcuk U Dent Fac. 2010;192:3-7
 
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