The role of anticholinergics in bronchoscopy - A randomized clinical trial

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, preve nt cardiac arrhythmias during the procedure, and increase patient comfort. Objective: To determine if atropine or glycopyrrolate, two anticholinergic agents utilized most frequently in this setting, have any significant role for this purpose. Design: Double-blind, placebo-controlled study, in which patients were rand omly selected to receive atropine (0.01 mg/kg body weight, IM injection), g lycopyrrolate (0.005 mg/kg, IM injection), or saline solution placebo (appr oximately 2 mL, IM injection) 15 to 45 min prior to being sedated with mida zolam 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 w ho 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 antisialagogi c effect, effectiveness in cough suppression, and overall patient comfort d uring the procedure. The patients completed a similar questionnaire after r ecovering from the procedure. Patients were also monitored for complication s (cardiac arrhythmias, oxygen desaturation, hypertension, wheezing, or cou ghing severe enough to curtail the procedure), There was no significant dif ference found among atropine, glycopyrrolate, and placebo for the primary e nd point of secretion control. In addition, there was no difference found b etween 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 benzodiazepines.