A study of the use of ultrasonically nebulized lignocaine for local anaesthesia during fibreoptic bronchoscopy

Gove, R. I.; Wiggins, James W.; Stableforth, D E

doi:10.1016/0007-0971(85)90007-5

Cited by 35 publications

(17 citation statements)

References 24 publications

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“…Pre vi ous stud ies (4,13) have dem on strated that sys temic se rum lev els of lido caine are well be low the rec om mended thera peu tic range of 2 to 6 mg/mL when the lido caine is de liv ered by ul tra sonic nebu lizer plus di rect in stil la tion of lido caine onto the mu cosa of the up per and lower air ways. To tal doses of lido caine de liv ered to the air ways were in the range of 450 to 540 mg in one study (4) and over 1600 mg in an other study (13). These val ues are sig nifi cantly higher than the maxi mum lido caine doses used in our study (ap proximately 400 mg).…”

Section: Discussioncontrasting

confidence: 51%

Superiority of Spacer/Mask Topical Anesthetic Compared with Conventional Spray and Gargle Method for Fibreoptic Bronchoscopy

Balkissoon¹,

Clelland²,

Whitehead³

et al. 1996

Canadian Respiratory Journal

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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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Section: Discussioncontrasting

confidence: 51%

Superiority of Spacer/Mask Topical Anesthetic Compared with Conventional Spray and Gargle Method for Fibreoptic Bronchoscopy

Balkissoon¹,

Clelland²,

Whitehead³

et al. 1996

Canadian Respiratory Journal

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“…Importantly, with both groups, the plasma concentration did not reach the accepted toxic plasma level of 5-10 lg.ml . Similarly, to achieve non-invasive airway topicalisation, larger than recommended doses of lidocaine have been administered via gel, nebulisation, or 'sprayas-you' go techniques without adverse consequences or excessive blood concentrations [12][13][14][15][16][17][18]. With regard to this study, the discrepancy between the relatively large doses of administered lidocaine and low plasma concentration may be explained by several factors.…”

Section: Discussionmentioning

confidence: 98%

Atomised lidocaine for airway topical anaesthesia in the morbidly obese: 1% compared with 2%*

et al. 2009

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SummaryAirway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in morbidly obese patients was evaluated using two doses of local anaesthetic. In this randomised, blinded prospective study, 40 ml of atomised 1% (n = 11) or 2% (n = 10) lidocaine was administered with high oxygen flow as carrier. Outcomes included time for intubation, patient tolerance to airway manipulation, haemodynamic parameters, the bronchoscopist's overall satisfaction, and serial serum lidocaine concentrations. Patients receiving lidocaine 1% had a longer mean (SD) time from the start of topicalisation to tracheal tube cuff inflation than those receiving lidocaine 2% (8.6 (0.9) min vs 6.9 (0.5) min, respectively; p < 0.05). Patients in the 1% cohort demonstrated increased responses to airway manipulation (p < 0.0001), reflecting lower bronchoscopist's satisfaction scores (p < 0.03). Haemodynamic responses to topicalisation and airway manipulation were similar in both groups. Peak plasma concentration was lower in the 1% group (mean (SD) 1.4 (0.3) and 3.8 (0.5) lg.ml )1 , respectively; p < 0.001). Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in the morbidly obese is efficacious, rapid and safe. Compared with lidocaine 1%, the 2% dose provides superior intubating conditions. Safe airway management in morbidly obese patients requiring general anaesthesia is of paramount importance and inadequate preparation may have dire consequences. At induction of anaesthesia, these patients can experience rapid arterial oxygen desaturation [1] and aspiration [2], and difficulties may be encountered at all levels of airway management including ventilation and intubation [3][4][5][6]. Securing the airway using awake fibreoptic intubation is considered to be a safe strategy [7], but this technique requires superior airway anaesthesia if excessive sedation is to be avoided. In the morbidly obese patient, obscured landmarks may limit the usefulness of invasive techniques (such as nerve blocks) to achieve airway anaesthesia [8]. Recently, we demonstrated that atomised lidocaine 2% or 4% is an efficacious, rapid and safe method to achieve topical airway anaesthesia in morbidly obese patients. However, the lowest optimum dose was not established [9]. This study was undertaken to compare atomised lidocaine 1% and 2% for airway anaesthesia during awake fibreoptic intubation in morbidly obese patients undergoing bariatric surgery. In a prospective, blinded and randomised investigation, main outcome measures included procedural time, patient tolerance to airway manipulation, haemodynamic parameters and serum lidocaine concentrations. The bronchoscopist's satisfaction level with intubating conditions and patients' tolerance to airway topicalisation were also assessed.

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“…Intravenous lidocaine has also been used to suppress the coughing associated with tracheal intubation (Yukioka et al, 1985). Topical lidocaine has been widely used to suppress the coughing associated with bronchoscopy, and a number of studies have supported this use via randomized double-blind placebo-controlled studies (Gove et al, 1985;Berger et al, 1989;Jakobsen et al, 1993). A good example of this is the study by Antoniades and Worsnop (2009), who demonstrated significantly lower cough rates after administration of 2% lidocaine versus normal saline when applied through a flexible bronchoscope.…”

Section: Local Anestheticsmentioning

confidence: 99%

Antitussive Drugs—Past, Present, and Future

et al. 2014

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A study of the use of ultrasonically nebulized lignocaine for local anaesthesia during fibreoptic bronchoscopy

Cited by 35 publications

References 24 publications

Superiority of Spacer/Mask Topical Anesthetic Compared with Conventional Spray and Gargle Method for Fibreoptic Bronchoscopy

Superiority of Spacer/Mask Topical Anesthetic Compared with Conventional Spray and Gargle Method for Fibreoptic Bronchoscopy

Atomised lidocaine for airway topical anaesthesia in the morbidly obese: 1% compared with 2%*

Antitussive Drugs—Past, Present, and Future

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