Nebulized versus Standard Local Application of Lidocaine during Flexible Bronchoscopy: A Randomized Controlled Trial

Abstract

Background: Endobronchial administration of local anesthetics such as lidocaine is often used for cough suppression during bronchoscopy. To achieve a better distribution of lidocaine in the tracheobronchial tree, spray catheters have been developed, allowing nebulization of the local anesthetic solution. However, there are little data on the efficacy and safety of this approach, or on the consumption of sedative drugs and lidocaine during nebulized administration. Objectives: To investigate the tolerability of nebulized lidocaine compared to conventional lidocaine administration via syringe through the working channel of the bronchoscope in patients undergoing bronchoscopy. Consumption of sedative drugs and lidocaine was also compared between the two lidocaine administration approaches. Methods: Patients requiring bronchoscopy with endobronchial or transbronchial biopsy were randomly assigned to receive topical lidocaine either via syringe or via nebulizer. Endpoints were consumption of lidocaine and sedative drugs, as well as patient tolerance and safety. Results: Thirty patients were included, 15 in each group. Patients in the nebulizer group required lower doses of endobronchial lidocaine (184.7 ± 67.98 vs. 250.7 ± 21.65 mg, p = 0.0045) and intravenous fentanyl (0.033 ± 0.041 vs. 0.067 ± 0.045 mg, p = 0.0236) than those in the syringe group; midazolam or propofol dosages did not differ between the two groups. In addition, there were no between-group differences in patient tolerance or safety (all p > 0.05). Conclusion: Endobronchial administration of lidocaine during bronchoscopy via nebulizer was found to be well tolerated and safe and was associated with reduced lidocaine and fentanyl dosages compared to administration via syringe.

Nebulization versus standard application for topical anaesthesia during flexible bronchoscopy under moderate sedation – a randomized controlled trial

“…Oxygen saturation (SpO 2 ) and heart rate were continuously monitored and recorded every 5 min from the beginning of the intervention until an ALDRETE (global assessment of post-aesthetic condition) score of at least 9 was recorded after the intervention. [ 8 , 9 ] Another ABG measurement was performed after completion of the procedure. All complications occurring during the procedure and within 24 h were recorded.…”

“…The sedation regimen was similar as described in our previous study. [ 8 ] However, a target sedation level of moderate was sought and – in contrast to the study mentioned above – patients were not intubated for the procedure. [ 8 ] Briefly, all patients received an intravenous bolus injection of midazolam.…”

“…[ 8 ] However, a target sedation level of moderate was sought and – in contrast to the study mentioned above – patients were not intubated for the procedure. [ 8 ] Briefly, all patients received an intravenous bolus injection of midazolam. After a waiting period, propofol boli were administered at the investigator’s discretion until sufficient patient tolerance for the procedure was achieved.…”

“…Patient tolerance was assessed using the Global Tolerance Score, based on a visual analogue scale (VAS; 0 = no bother, 100 = intolerable); the same VAS was used to rate four specific sensations: nausea, asphyxia, cough and pain (0 = non-existent, 100 = unbearable). The Tolerance Score, defined as the arithmetic mean of global tolerance VAS score and the mean of scores for the 4 specific sensations, was calculated as described previously [ 4 , 8 ]. The American Society of Anaesthesiologists’ (ASA) score was used to assess physical status [ 10 ].…”

“…Therefore, spray catheters such as the Enk Fiberoptic Atomizer Set® have been developed, which allow nebulization of lidocaine during the bronchoscopy procedure using a constant oxygen flow [ 6 ]. This device was initially designed for use during awake fiberoptic intubation but can also be used safely during diagnostic bronchoscopies by respiratory physicians, as demonstrated in a recent clinical trial in which topical lidocaine administration via nebulizer was associated with reduced consumption of lidocaine and fentanyl compared with administration via syringe [ 7 , 8 ]. However, because all diagnostic bronchoscopies in that trial were performed under deep sedation to allow fiberoptic intubation, the conclusions drawn cannot necessarily be transferred to procedures performed under moderate or light sedation without fiberoptic intubation.…”