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Three Part Question

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]?

Clinical Scenario

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.

Search Strategy

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}]

Search Outcome

No relevant papers were found

Comment(s)

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

Clinical Bottom Line

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