Atropine as a pre-procedure medication in elective pleural aspiration

June 15, 2005

September 29, 2005

Shweta Gidwani, Clinical Effectiveness Fellow (Manchester Royal Infirmary)

IN [patients undergoing pleural aspiration in the ED for a non life treatening pneumothorax] IS [pre-medication with Atropine useful] AT [preventing a vaso-vagal attack during the procedure]?

A 24 yr old, otherwise fit and health student presents to the ED with pleruritic chest pain and shortness of breath. On examination he has absent breath sounds in the upper zone on the right side of his chest and his chest X ray confirms your clinical suspicion of a spontaneous pneumothorax. You decide to aspirate the pneumothorax. You have heard that this procedure may cause a vasovagal sycope and wonder whether this may be prevented by a injection of atropine prior to the procedure.

MEDLINE 1966 to Week 4 August 2005using OVID interface

[{exp ATROPINE/ or atropine.mp.} AND {exp Empyema, Pleural/ or exp Drainage/ or exp Pleural Effusion/ or pleural aspiration.mp. or exp Pneumothorax/ or exp Pleural Diseases/ or exp Thoracostomy/ or thoracocentesis.mp. or exp Paracentesis or chest drain.mp}]

No relevant papers were found

There is some concern about vagal responses such as bradycardia and hypotension associated with endotracheal suctioning in ventialted patients. Some studies have shown some benefit with premedicating these patients with nebulised atropine or parentral atropine (im or iv) to prevent this vagus mediated response. However no studies have been done to detremine the use of atropine as premedication for pleural aspiration or tube thoracostomy

Routine use of atroipne as a premedication to prevent vagal reponses is not recommended in the ED.