Forbes Nauzer, Frehlich Levi, Borgaonkar Mark, Leontiadis Grigorios I, Tse Frances
Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
J Can Assoc Gastroenterol. 2021 Oct 12;4(6):259-268. doi: 10.1093/jcag/gwab038. eCollection 2021 Dec.
Hyoscine butylbromide, also known as hyoscyamine or scopolamine, and sold under the trade name Buscopan, is an antimuscarinic agent commonly used to induce smooth muscle relaxation and reduce spasmodic activity of the gastrointestinal (GI) tract during endoscopic procedures. However, the balance between desirable and undesirable (adverse) effects is not clear when used during GI endoscopy. The Clinical Affairs Committee of the Canadian Association of Gastroenterology (CAG) conducted systematic reviews and applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to develop recommendations for the use of Buscopan during GI endoscopy. To summarize, we recommend against the use of Buscopan before or during colonoscopy (). We suggest against the use of Buscopan before or during gastroscopy (). We suggest the use of Buscopan before or during ERCP (). More research is needed to determine whether patients undergoing advanced procedures such as endoscopic mucosal resection or endoscopic submucosal dissection benefit from its use. Buscopan should be used with caution in patients with cardiac comorbidities. According to its product monograph, Buscopan is contraindicated in patients with tachycardia, angina, and cardiac failure. Thus, Buscopan should be used very cautiously in patients with these conditions, and only when the potential benefits of its use outweigh the potential risks in a particular case. Such patients require careful cardiac monitoring in an environment where resuscitation equipment and appropriately trained staff to use it are readily available. According to its product monograph, Buscopan is also contraindicated in patients with prostatic hypertrophy with urinary retention, and therefore, should be used very cautiously in such patients as well, and only when the potential benefits of its use outweigh the potential risks in a particular case. Obtaining a preprocedural history of glaucoma is unlikely to be of value when considering Buscopan use. However, in cases where Buscopan has been used, patients should be counselled postprocedurally and told to present to an emergency facility should they experience eye pain, redness, decreased vision, nausea and vomiting or headache.
丁溴东莨菪碱，也被称为天仙子碱或东莨菪碱，以商品名“解痉灵”销售，是一种抗毒蕈碱剂，常用于在内镜检查过程中诱导平滑肌松弛并减少胃肠道（GI）的痉挛活动。然而，在胃肠道内镜检查期间使用时，预期效果与不良（有害）效果之间的平衡尚不清楚。加拿大胃肠病学协会（CAG）临床事务委员会进行了系统评价，并应用推荐分级评估、制定和评价（GRADE）方法来制定关于在胃肠道内镜检查期间使用解痉灵的建议。总之，我们不建议在结肠镜检查前或检查期间使用解痉灵（）。我们不建议在胃镜检查前或检查期间使用解痉灵（）。我们建议在逆行胰胆管造影（ERCP）前或检查期间使用解痉灵（）。需要更多研究来确定接受诸如内镜黏膜切除术或内镜黏膜下剥离术等高级手术的患者是否能从其使用中获益。有心脏合并症的患者应谨慎使用解痉灵。根据其产品说明书，心动过速、心绞痛和心力衰竭患者禁用解痉灵。因此，患有这些疾病的患者应非常谨慎地使用解痉灵，并且仅在特定情况下其使用的潜在益处超过潜在风险时才可使用。此类患者需要在具备复苏设备和经过适当培训可使用该设备的工作人员的环境中进行仔细的心脏监测。根据其产品说明书，患有前列腺肥大伴尿潴留的患者也禁用解痉灵，因此，对此类患者也应非常谨慎地使用，并且仅在特定情况下其使用的潜在益处超过潜在风险时才可使用。在考虑使用解痉灵时，获取术前青光眼病史不太可能有价值。然而，在已使用解痉灵的情况下，术后应向患者提供咨询，并告知他们如果出现眼痛、眼红、视力下降、恶心、呕吐或头痛，应前往急诊机构就诊。
