Topical Anesthesia for Bronchoscopy

Perry, Lawrence B.

doi:10.1378/chest.73.5_supplement.691

Cited by 28 publications

(8 citation statements)

References 15 publications

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“…It has been suggested that the total dose should be limited to 300–400 mg[5] as absorption of lignocaine from the respiratory mucosa is known to be rapid. [6] Lignocaine toxicity is directly correlated with its concentration in the blood. The risk of more serious side effects increases when blood concentrations exceed 5 mg/l, with seizures and hallucinations occurring at concentrations of 8–12 mg/l and cardiorespiratory arrest at 20–25 mg/l.…”

Section: Discussionmentioning

confidence: 99%

Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

2011

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Aim:The aim of the study was to compare transcricoid injection with spray as you go technique for diagnostic fibreoptic bronchoscopy, to perform the procedure without sedation and to record any complication or side effects.Methods:Sixty patients belonging to the age group 20–70 years, undergoing diagnostic bronchoscopy over a period of 6 months, were randomly selected and divided into two groups alternatively to receive 3 ml of 4% lignocaine by a single transcricoid puncture (group I) or 2 ml of 4% lignocaine instilled through the bronchoscope on to the vocal cords and further 1 ml of 2% lignocaine into each main bronchus (group II). Additional dose of lignocaine as required was given in both the groups. All patients were given intramuscular atropine 0.6 mg, 20 min before the procedure. Nebulisation with 3 ml of 4% lignocaine was given to all patients. The time from nasal insertion of the bronchoscope to reach the carina was recorded, and the total dose of lignocaine required in both the groups was calculated and compared. The cough episodes during the procedure, systolic blood pressure, and pulse rate were compared before the procedure and 5 min after the procedure in both the groups. A0–10 visual analogue scale (VAS) was used to assess discomfort 30 min after the procedure.Results:The time to reach carina was more in group II (P<0.02), and cough episodes were also more in group II (P<0.05) than in group I. The vitals before the procedure were comparable in both the groups, but 5 min after the procedure the vitals were more stable in group I than in group II, and the total dose of lignocaine required in group II was more than in group I (P<0.001). However, the VAS score was comparable in both the groups.Conclusion:Transcricoid puncture for diagnostic bronchoscopies without sedation was associated with no complication and discomfort and required lesser dose of local anaesthetic with more stable vitals and good conditions for bronchoscopists.

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Section: Discussionmentioning

confidence: 99%

Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

2011

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“…Lidocaine has been the topical anesthetic of choice for bronchoscopy [1] , [2] , [3] . There has been debate over the route of delivery and concentration of lidocaine during bronchoscopy [4] , [5] , [6] , [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Lidocaine specifically has been thought to have sensitizing properties relative to other amide anesthetics. Past alternatives have included tetracaine and cocaine [1] . In this case, the patient had experienced hypersensitivity reactions to multiple medications applied topically or infiltrated via mucosal or intradermal injection, but had tolerated chloroprocaine.…”

Section: Discussionmentioning

confidence: 99%

“…Topical anesthesia has been a mainstay to provide relief and blunt the cough reflex during bronchoscopy. In the past, topical agents used have included lidocaine, tetracaine, benzocaine, and cocaine; lidocaine being the most popular [1] . The American College of Chest Physicians have released a statement suggesting that lidocaine is the preferred topical anesthetic agent of choice, given its short half-life and favorable side effect profile [2] .…”

Section: Introductionmentioning

confidence: 99%

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Alternative topical anesthesia for bronchoscopy in a case of severe lidocaine allergy

Hensley

Singer

2018

Respiratory Medicine Case Reports

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“…Various modes of administration for topical anesthesia have been reported, including soaked swabs, direct instillation, aerosol spray, nebulization, transcricoid or transtracheal injection, local nerve block, or the “spray-as-you-go technique” (through the working channel of the bronchoscope) [ 9 , 15 , 16 , 17 , 18 ]. Interestingly, placebo-controlled trials comparing use of nebulized lidocaine versus nebulized saline, in combination with topical lidocaine in the nasopharynx, vocal cords and airways revealed no difference with regard to coughing or patient discomfort [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Topical Nasal Anesthesia in Flexible Bronchoscopy – A Cross-Over Comparison between Two Devices

et al. 2016

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IntroductionTopical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB). Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients.MethodsUsing a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA). Those enrolled between 25-11-2014 and 30-01-2015, received a disposable intranasal mucosal atomization device (DIMAD). After each procedure, the treating physician, their assistant and the patient independently rated side-effects and satisfaction, basing their responses on visual analogue scales (VAS). At their next scheduled bronchoscopy during the study period, patients then received the alternative atomizer. Written consent was obtained prior to the first bronchoscopy, and the study approved by the institutional ethics committee.ResultsOf the 252 patients enrolled between 01-10-2014 and 30-01-2015, 80 (32%) received both atomizers. Physicians reported better efficacy (p = 0.001) and fewer side effects (p< = 0.001) for DIMAD in patients exposed to both procedures. Among patients with one visit, physicians and their assistants reported improved efficacy (p = 0.018, p = 0.002) and fewer side effects (p< = 0.001, p = 0.029) for the disposable atomizer, whereas patients reported no difference in efficacy or side effects (p = 0.72 and p = 0.20). No severe adverse events were noted. The cost of the reusable device was 4.08€ per procedure, compared to 3.70€ for the disposable device.DiscussionTopical nasal anesthesia via a disposable intranasal mucosal atomization device (DIMAD) offers comparable safety and patient comfort, compared to conventional reusable nasal atomizers (CRNA) in lung transplant recipients. Procedural costs were reduced by 0.34€ per procedure.Trial Registrationclinicaltrials.gov NCT02237651

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Topical Anesthesia for Bronchoscopy

Cited by 28 publications

References 15 publications

Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

Alternative topical anesthesia for bronchoscopy in a case of severe lidocaine allergy

Topical Nasal Anesthesia in Flexible Bronchoscopy – A Cross-Over Comparison between Two Devices

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