Chest
Volume 102, Issue 3, September 1992, Pages 704-707
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Clinical Investigations
Comparison of Three Different Methods Used to Achieve Local Anesthesia for Fiberoptic Bronchoscopy

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A patient's tolerance of fiberoptic bronchoscopy depends on the effectiveness of local anesthesia. This study compares the three different methods of local anesthesia in common use After sedation, patients (n = 53) received either 4 ml of 2.5 percent cocaine by intratracheal injection (TI) (n = 18), by bronchoscopic injection (BI) (n = 19), or had 4 ml of 4 percent lidocaine delivered by nebulizer 20 min before the procedure (NEB) (n = 16). Patients and bronchoscopist's scored the procedure using visual analog (VAS) and severity scales. Objective measurements of cough counts and episodes of stridor were recorded by phonopneumography. Patients’ VAS scores showed a clear preference for the transtracheal method compared with either bronchoscopically injected cocaine (p<0.001) or nebulized lidocaine (p<0.001). Patients also reported that the TI method produced less cough during intubation of the larynx and inspection of the airways (BI and NEB, p<0.01). The TI method was also preferred by the bronchoscopist's (BI and NEB, p<0.001); they reported less cough and easier trachea] intubation. The mean cough count was significantly lower for the TI group, 49 (43) compared with 95 (52) for BI (p<0.01), and 81 (43) for the NEB group (p<0.05). Patients’ and bronchoscopists’ VAS showed significant correlation with cough (r = 0.63-69, p<0.01). Stridor occurred in only two patients after TI, compared with 15 in the other two groups. Extra local anesthesia was required by 16 patients after BI, by all the NEB group, but by only one patient after TI. Subjective and objective measurement shows that 4 ml of 2.5 percent cocaine injected into the trachea produced excellent local anesthesia for fiberoptic bronchoscopy, there were no extra complications, and it was the method preferred by both patients and bronchoscopists.

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)

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Manuscript received April 29; revision accepted December 2.

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