A prospective study of atropine premedication in flexible bronchoscopy

Aim: This study aimed to assess the effect of atropine premedication prior to flexible bronchoscopy. The rationale for using atropine is that it will dry secretions and allow a better view of the bronchial tree. There is also the theoretical benefit of protection against vasovagal episodes and bronc hospasm. Methods: Twenty patients were randomised in a double-blind manner to receiv e either 500 mcg of atropine intramuscularly or 1 mL of 0.9% saline intramu scularly 30 minutes prior to bronchoscopy. Both groups received a standard dose of intramuscular pethidine. Variables studied included a pre-procedure electrocardiograph, a rhythm strip during the procedure, serial measuremen ts of blood pressure, continuous pulse oximetry, and spirometry pre- and po st-bronchoscopy. Subjective measures recorded were a secretion score, rated 0-3 by the bronchoscopist using a four point visual analogue scale. A pati ent questionnaire was designed to establish the presence or absence of symp toms, including those related to atropine. Results: There were no significant differences recorded in the duration of procedure, percentage fall in FEV1, secretion scores, or other physiologica l measures. The only significant difference between the two groups was dry mouth in the atropine group (p<0.001). There was a fall in forced vital cap acity from baseline which was significant in the saline group (p<0.005), an d not the atropine group, but it was not significant when compared between groups. A beta(2) adrenergic agonist would, however, be more appropriate to prevent such a fall in spirometry. Conclusions: These results fail to demonstrate a benefit of intramuscular a tropine as premedication for fibreoptic bronchoscopy.