Chest
Clinical InvestigationsComparison of Three Different Methods Used to Achieve Local Anesthesia for Fiberoptic Bronchoscopy
Section snippets
Patients
Fifty-three patients who had not had a previous bronchoscopy were randomized into three groups: 19 receiving local anesthetic via the suction channel of the bronchoscope (bronchoscopic injection group, BI), 18 by the transtracheal route (tracheal injection group, TI), and 16 had nebulized lidocaine before the procedure (NEB).
The groups were well matched for age, sex, spirometry, and incidence of chronic obstructive pulmonary disease. A similar number of patients in each group used metered dose
Subjective Assessment
The patients’ VAS for symptoms (Fig 1) showed a highly significant overall preference for the transtracheal method together with lower scores for coughing and choking.
The severity scores recorded by the patients showed no significant difference in the nasal anesthesia (mean scores of 2.1, 1.8, and 2.4 or in anesthetizing the larynx (mean score of 1.9, 2.6, and 2.5). However, intubation of the larynx by TI was preferred to BI and NEB (TI mean scores being 1.0 [0.2] compared with 2.2 [1.1] for BI
Discussion
This study was performed to evaluate three different methods of providing local anesthesia for fiberoptic bronchoscopy. Subjective assessments by patients and bronchoscopists using VAS and severity scores were compared with objective measurements of cough, stridor, and total quantity of local anesthesia required for each bronchoscopy.
Despite the two injections involved, patients’ VASs showed a significant overall preference for the transtracheal method of anesthesia (Fig 1). Using severity
ACKNOWLEDGMENTS
We thank our respiratory physiology technicians and bronchoscopy nurses for their help with this study. We also thank Drs. Pearson, Calverley, and Davies for allowing us to investigate their patients.
References (13)
Local anaesthesia for fibreoptic bronchoscopy: where are we now?
Respir Med
(1990)- et al.
Serum lidocaine concentrations in children during bronchoscopy with topical anaesthesia
Chest
(1990) - et al.
Premedication for fibreoptic bronchoscopy
Thorax
(1983) - et al.
Premedication for bronchoscopy: a comparison of neuroleptanalgesia, diazepam and papaveretum
Thorax
(1987) - et al.
Postal survey of bronchoscopie practice by physicians in the UK
Thorax
(1986) - et al.
Nebulized lignocaine as anaesthesia for fibreoptic bronchoscopy
Thorax
(1984)
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Sedation in Bronchoscopy: A Review
2018, Clinics in Chest MedicineLocal airway anaesthesia for awake fibreoptic intubation
2016, Trends in Anaesthesia and Critical CareCitation Excerpt :The atomizer technique was superior to bolus application of local anaesthesia. Patients who received mucosal anaesthesia with the Enk Fiberoptic Atomizer Set™ reported a better level of comfort (IQR [range]) VAS; 1 ([1–3]) vs. 4 ([2–6]), p < 0.0001, experienced fewer coughs (6 [3–10], control: 11 [6–13]; p = 0.0055) and fewer distinct coughing episodes (7%, control: 27%; p = 0.0133). The atomizer technique was faster (5 min [3–6] vs. control: 6 [4–7]; p = 0.0009) and required less topical lidocaine (100 mg [100–100 mg] vs. control: 200 mg [200–200 mg]; p = 0.0001) [31].
Preparation of the Patient for Awake Intubation
2013, Benumof and Hagberg's Airway ManagementPreparation of the Patient for Awake Intubation
2012, Benumof and Hagberg's Airway Management: Third Edition
Manuscript received April 29; revision accepted December 2.