Intravenous Atropine as Pre-Medication for Upper Gastrointestinal Endoscopy: Re-evaluation of Its Utility

Abstract

Background: Atropine amongst other anti-cholinergic agents given as pre-medication is still being used by some as an adjunct to conscious sedation for upper gastrointestinal endoscopy (UGIE) (J Gastroenterol Hepatol 1998;13:816-820, J Clin Gastroenterol 1998:26:253-255, Aliment Pharmacol Ther 2002; 16:111-118). Its use is no longer universal due to its adverse effects and uncertain benefits. We examined the use of atropine given routinely for UGIE in terms of adverse effects and facilitation of UGIE. Methods: A double-blinded prospective randomised trial was performed in which 96 consecutive patients undergoing UGIE by a single endoscopist were randomised to receive either 0.6mg atropine intravenously or saline as placebo, in addition to conscious sedation with midazolam. No patients received pharyngeal local anesthesia. Outcome measures included the amount of oral secretions (Gastrointest Endosc 1983;29(4):285-288). Pyloric diameter (noted as normal or tight) and ease of duodenal intubation (rapid or delayed) were assessed by the endoscopist. Maximum and minimum heart rate were recorded for each patient. Patients were asked to report dry mouth or visual disturbance post procedure. Results: Atropine administration significantly increased the mean minimum and maximum heart rates compared to placebo: 84.0 vs. 78.2 (P=0.03) and 110.7 vs. 101.6 (P=0.03), respectively. There were no significant differences in oral secretions, estimated pyloric diameter or ease of duodenal intubation. Patients were more likely to complain of a dry mouth after atropine (25/48 vs.15/48, P<0.002). No patients complained of visual disturbance. Conclusions: The routine use of atropine during UGIE does not provide significant benefit for patients nor endoscopist and can cause unpleasant side effects.