Premedication with ipratropium bromide for bronchoscopy produces subjective discomfort without significant clinical benefit

Premedication with ipratropium bromide has been reported to prevent bronchoconstriction during bronchoscopy, but the potential benefits of this treatment have not been fully investigated. Thus we studied the effects of inhaled ipratropium bromide on the ease, acceptability, and complications of bronchoscopy in a randomized, placebo-controlled, double-blind study of 28 elderly male veterans. None of the patients developed tachycardia, tachyarrhythmias, oxygen desaturation, or wheezing during bronchoscopy. Premedication with ipratropium did not alter significantly the incidence of elevations in blood pressure or cough requiring interruption of the procedure, nor did it affect the total amounts of sedatives or lidocaine used during the procedure. Patient comfort during the bronchoscopy was perceived by the "blinded" physicians and nurses to be similar between ipratropium- and placebo-treated groups, and the bronchoscopists rated the procedures to be equally easy to perform in all subjects. However, patients receiving inhaled ipratropium were significantly less willing to repeat bronchoscopy, even if clinically indicated, and tended to regard the procedure as less comfortable, compared with patients receiving saline placebo. Thus we conclude that routine premedication with inhaled ipratropium bromide before bronchoscopy cannot be recommended.