Su pe ri or ity of spacer/mask topi cal an aesthetic com pared with con ven tional spray and gar gle method for fi bre op tic bron cho scopy. Can Respir J 1996;3(3):176-180. OB JEC TIVE:To com pare the safety and ef fi cacy of a new spacer-oral na sal mask de vice with those of the stan dard nee dle noz zle spray method for the de liv ery of aero sol ized lido caine to the up per air way for pre-bronchoscopic an aesthe sia in a ter ti ary care hos pi tal. DE SIGN: Single-blind ran dom ized con trol trial. SET TING: Uni ver sity af fili ated ter ti ary care hos pi tal, ambu la tory care bron cho scopy unit. SUB JECTS: Thirty con secu tive con sent ing pa tients re ferred for fi bre op tic bron cho scopy for vari ous in di cations. IN TER VEN TION:Thirty ran dom ized sub jects re ceived 150 mg of topi cal 1% aero sol ized lido caine via stan dard long nee dle nosed ap pli ca tor (group A) or via a new oral/ na sal mask with spacer de vice (group B). Bron cho scopists, blinded as to the pre pro ce dure topi cal an aes thetic method used, gave ad di tional topi cal lido caine at their dis cre tion. MEAS URE MENTS:The study nurse re corded the to tal dose of lido caine (mg), tim ing of the pro ce dure (s), cough fre quency ex pressed as coughs per minute (c/min), vi tal signs, time for re turn of gag re flex and pa tients' sub jec tive com ments. RE SULTS: Fif teen pa tients were ran dom ized to each group. The lido caine dose re quired for in ser tion through the vo cal cords (mean ± SD) was 282.6±66.3 mg in group A and 203.3±70.6 mg in group B (P<0.005). To tal lido caine dose re quired for the pro ce dure was 330.6±70.2 mg in group A and 256.6±75 mg in group B (P<0.01). The mean time for pas sage of the bron cho scope from mouth en try to through the vo cal cords was 82.7±54.5 s in group A and 110.5±64.4 s in group B (P>0.1). The mean to tal time for the pro ce dure was 699.7±377.5 s in group A and 697.2±409.1 s in group B (not sig nifi cant). The mean cough fre quency was 8.2±6.1 c/min in group A and 7.0±5.7 c/min in group B (not sig nifi cant). There were no sta tis ti cally signifi cant dif fer ences in heart rate, in re turn of gag re flex time or in com pli ca tion rate be tween the two groups. CON CLU SIONS: A sta tis ti cally sig nifi cant re duc tion in the dose of lido caine is re quired to achieve equiva lent topical an aes thetic for bron cho scopy with a new mask and spacer de vice com pared with a more con ven tional method. Since no other vari ables re lated to the pro ce dure showed a sig nifi cant dif fer ence, the new method ap pears to be su perior to the pre vi ous method. (Pour rés umé voir page 177)
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