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  1. Mason

    November 11, 2018 at 9:02 pm

    Thanks for this great talk, the points about the ‘death rattle’ were particularly eye interesting.

    I’d be interested to know if Glycopyrollate is thought to have any negative effect or just no evidence or benefit?

    • Jessica Borbasi

      November 12, 2018 at 3:15 pm

      Hi Mason,

      Thank you for your comment. Below is some information – Don’t forget that anticholinergic side effects can include- dry mouth, confusion, constipation and urinary retention- not insignificant in the dying patient and these drugs can be expensive.

      Cochrane Review: There is no evidence that any intervention, pharmacological or nonpharmacological is superior to placebo in the treatment of noisy breathing in dying patients. We acknowledge that in the face of heightened emotions when death is imminent, it is difficult for staff not to intervene- however if anticholinergics are used adverse effects such as dry mouth, urinary retention & constipation must be monitored.

      Prevalence, Impact, and Treatment of Death Rattle: A Systematic Review- Lokker et al. (2014). We identified 39 articles, of which 29 reported on the prevalence of death rattle, eight on its impact, and 11 on the effectiveness of interventions. There is a wide variation in reported prevalence rates (12%–92%; weighted mean, 35%). Death rattle leads to distress in both relatives and professional caregivers, but its impact on patients is unclear. Different medication regimens have been studied, that is, scopolamine, glycopyrronium, hyoscine butylbromide, atropine, and/or octreotide. Only one study used a placebo group. There is no evidence that the use of any antimuscarinic drug is superior to no treatment.

      Common medications with anticholinergic effects:
      Morphine, oxycodone, midazolam, lorazepam, dexamethasone, prednisolone, cyclizine, levomepromazine, hyoscine, glycopyrrolate, sodium valproate, digoxin, olanzapine, frusemide


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