1% Versus 2% Lignocaine for Airway Anesthesia in Flexible Bronchoscopy Without Lignocaine Nebulization (LIFE)

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.

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“…Large RCTs in no-sedation bronchoscopy have been performed with pharyngeal anesthesia using lignocaine spray. [150151]…”

Section: Premedicationmentioning

confidence: 99%

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

et al. 2019

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“…However, 10% of pulmonologists and 12.5% of thoracic surgeons reported routine use of atropine. Randomized control studies have shown that the use of 1% lidocaine in “spray as you go” technique is effective and safe with significantly less total dose of lidocaine administered when compared to 2% lidocaine 19,20. In our survey, use of topical anesthetics deviated from the evidence to some extent.…”

Section: Discussionmentioning

confidence: 71%

Survey of flexible bronchoscopy practice in adults in Saudi Arabia

Aljohaney

Albanna

Alhajji

et al. 2019

SMJ

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Objectives: To assess current adherence to international guidelines for practitioners of bronchoscopy in the Kingdom of Saudi Arabia. Methods: A cross-sectional survey was conducted in Saudi Arabia between December 2016 and March 2017. Pulmonologists, thoracic surgeons, and intensivists were invited to answer an emailed self-administered questionnaire survey seeking information on how they performed flexible bronchoscopy in adults. The data collected were compared between the 3 specialties. Results: Eighty-two (18%) of 456 invited practitioners completed the survey. Fifty-eight (72%) of the 82 respondents were pulmonologists. Forty (53%) of 76 respondents (93%) who had received bronchoscopy training received it abroad. Twenty-seven respondents (33%) had also received training in endobronchial ultrasound, electrocautery, brachytherapy, stent insertion, and laser procedures. Fifty-eight respondents (70%) preferred patients to undergo fasting for at least 4 hours before the procedure. Lidocaine was used for topical anesthesia, mainly by aerosol spray or nebulization. Midazolam was used by 62%, fentanyl by 50%, and propofol by 12% of respondents. Ninety percent of pulmonologists reported requesting a chest radiograph after transbronchial lung biopsy. Safety procedures for bronchoscopists, for example, wearing masks and eye protection, and for patients, for example, availability of anesthetic reversal agents, were not universally applied. Conclusion: Bronchoscopy is not standardized in Saudi Arabia. National guidelines for the indications and practice of bronchoscopy are required.

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“…Although, at the time of this study, we were routinely using nebulized lignocaine administration before EBUS-TBNA, the evidence to support nebulized lignocaine administration during bronchoscopy is weak. [ 4 ] All the EBUS-TBNA procedures in our study were performed through the oral route; therefore, the results may not be applicable to nasal route for performing the procedure. Nasal route has also been found safe and feasible to perform EBUS-TBNA though the requirement of lignocaine is likely to be higher in this case as nasal lignocaine gel application is additionally required.…”

Section: Discussionmentioning

confidence: 99%

“…Two large randomized controlled trials (RCTs) comparing 1% versus 2% lignocaine concentrations during flexible bronchoscopy (most procedures performed without sedation) have demonstrated equal efficacy of both concentrations for procedural satisfaction and cough suppression. [ 3 4 ] Performance of EBUS-TBNA with exclusive use of topical anesthesia is uncommon. [ 5 ] The available guidelines and expert panel report on technical aspects of EBUS-TBNA do not clarify the optimum lignocaine concentration for topical anesthesia during the procedure.…”

Section: Introductionmentioning

confidence: 99%

1% versus 2% lignocaine for airway anesthesia in endobronchial ultrasound-guided transbronchial needle aspiration: A pilot, double-blind, randomized controlled trial

et al. 2018

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Background and Objectives:No previous study has compared different concentrations of lignocaine for topical anesthesia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In this pilot study, we compared 1% versus 2% lignocaine for topical airway anesthesia during EBUS-TBNA.Methods:In this double-blind, randomized trial, subjects were randomized to receive either 1% or 2% lignocaine for “spray-as-you-go” administration. All received combined moderate intravenous sedation (midazolam and fentanyl). Ten percent pharyngeal lignocaine spray (two sprays) and nebulized lignocaine (2.5 ml of 4% solution) were administered to all subjects. Administration of additional lignocaine was allowed at operator's discretion. The primary endpoints were operator-rated overall procedural satisfaction and cough, each assessed on visual analog scale (VAS), while the secondary outcomes included patient-rated faces pain scale scores, cumulative lignocaine dose, number of subjects receiving lignocaine >8.2 mg/kg, doses of midazolam/fentanyl between groups, and adverse events during procedure.Results:The mean (standard deviation [SD]) VAS scores for operator-rated procedure satisfaction were 64.2 (25.6) and 68.7 (23.7) in 1% and 2% group, respectively (P = 0.35). The median (interquartile range) VAS scores for operator-rated cough were 48.4 (23.9–69.9) in 1% group and 38.7 (18.6–69.5) in 2% group (P = 0.24). The mean [SD] cumulative lignocaine received in the 2% lignocaine group (248.6 [29.1] mg) was significantly greater than in 1% lignocaine group (178.5 [14.6] mg) (P < 0.01).Conclusion:One percent lignocaine is equally efficacious as 2% lignocaine for topical anesthesia during EBUS-TBNA, at a significantly lower cumulative lignocaine dose.

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1% Versus 2% Lignocaine for Airway Anesthesia in Flexible Bronchoscopy Without Lignocaine Nebulization (LIFE)

Abstract: One percent lignocaine in flexible bronchoscopy is as efficacious as 2% lignocaine when administered using the spray as you go technique without concurrent lignocaine nebulization, at a significantly lower total dose of lignocaine administered.

Cited by 18 publications

References 13 publications

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Survey of flexible bronchoscopy practice in adults in Saudi Arabia

1% versus 2% lignocaine for airway anesthesia in endobronchial ultrasound-guided transbronchial needle aspiration: A pilot, double-blind, randomized controlled trial

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