A M Fink1, G W Aylward. 1. Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
Abstract
UNLABELLED: Hyoscine butylbromide (Buscopan) is commonly used by radiologists in the UK as a hypotonic agent in double-contract gastrointestinal studies. A history of glaucoma is still taught to be the prime contraindication to its use, although the only individuals at risk are those with undiagnosed and therefore untreated angle closure glaucoma (ACG), who will not give a positive history. We conducted a postal survey of all members and fellows of the Royal College of Radiologists in the UK to establish current practice. RESULTS: Of the 1045 respondents who use Buscopan, 724 (81.6%) withhold it if the patient gives a history of glaucoma, and 631 (87.2%) of this group substitute glucagon. Of the 51 respondents who state that they understand that the patient who gives the positive history is not the one at risk, 22 continue to withhold Buscopan because of the established teaching. Only 429 (52.4%) substitute glucagon for Buscopan if the patient gives a history of heart disease. Eight respondents (0.8%) have seen an attack of glaucoma thought to have been precipitated by Buscopan, and 20 (1.9%) have seen cardiac complications. CONCLUSION: There are still widespread misconceptions about the contraindications to the use of Buscopan among radiologists in the UK. We recommend abandoning the practice of enquiring about a history of glaucoma, and substituting advice to seek urgent medical advice should eye pain and visual loss develop. Caution in the patient with heart disease appears to be of greater importance.
UNLABELLED: Hyoscine butylbromide (Buscopan) is commonly used by radiologists in the UK as a hypotonic agent in double-contract gastrointestinal studies. A history of glaucoma is still taught to be the prime contraindication to its use, although the only individuals at risk are those with undiagnosed and therefore untreated angle closure glaucoma (ACG), who will not give a positive history. We conducted a postal survey of all members and fellows of the Royal College of Radiologists in the UK to establish current practice. RESULTS: Of the 1045 respondents who use Buscopan, 724 (81.6%) withhold it if the patient gives a history of glaucoma, and 631 (87.2%) of this group substitute glucagon. Of the 51 respondents who state that they understand that the patient who gives the positive history is not the one at risk, 22 continue to withhold Buscopan because of the established teaching. Only 429 (52.4%) substitute glucagon for Buscopan if the patient gives a history of heart disease. Eight respondents (0.8%) have seen an attack of glaucoma thought to have been precipitated by Buscopan, and 20 (1.9%) have seen cardiac complications. CONCLUSION: There are still widespread misconceptions about the contraindications to the use of Buscopan among radiologists in the UK. We recommend abandoning the practice of enquiring about a history of glaucoma, and substituting advice to seek urgent medical advice should eye pain and visual loss develop. Caution in the patient with heart disease appears to be of greater importance.