Chest

Chest

Volume 112, Issue 6, December 1997, Pages 1665-1669
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Bronchoscopy
Nebulized Lidocaine Administered to Infants and Children Undergoing Flexible Bronchoscopy

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Study objectives

The purpose of this study was to evaluate the safety and efficacy of nebulized lidocaine hydrochloride as a topical anesthetic for use during flexible bronchoscopy in infants and children.

Design

This was a prospective, randomized, double-blind study.

Patients

Twenty consecutive patients scheduled for flexible bronchoscopy who were not intubated and had no known cardiac or hepatic disease comprised the study group.

Interventions

The patients were randomized to receive either 8 mg/kg or 4 mg/kg of nebulized 2% lidocaine by face mask prior to bronchoscopy.

Setting

The study took place in a bronchoscopy suite at an academic medical center.

Measurements

To determine systemic absorption, serum lidocaine levels were obtained. To assess efficacy of nebulized lidocaine as a topical anesthetic, changes in heart rate and blood pressure were recorded, and the bronchoscopist (who did not know the lidocaine dose used) rated the ease of passage of the bronchoscope through nose, vocal cords, trachea, bronchi, and all sites overall, and the degree of cough.

Results

Nebulized lidocaine was safe, was well-tolerated, and provided adequate anesthesia for half of the patients. The serum lidocaine levels were much lower than the levels in the toxic range. There was a trend toward easier passage of the bronchoscope in the high-dose group at all sites noted previously that were evaluated.

Conclusion

Nebulized lidocaine in doses up to 8 mg/kg appears to be safe and moderately effective as a topical anesthetic for flexible bronchoscopy in infants and children. The serum levels were remarkably low. Fifty percent of the subjects required no supplemental lidocaine.

Section snippets

Study Participants

Twenty infants and children were enrolled in the study. Approval for the study was obtained from the Institutional Review Board, and informed consent was obtained from the subjects’ parents. Patients were eligible if they were undergoing FOB for diagnostic or therapeutic purposes. Exclusion criteria included patients with known hepatic or cardiac disease and intubated patients. The patients were randomized into two groups: group 1 subjects received a low dose of 4 mg/kg of 2% lidocaine and

Results

The patients in both groups were similar in indications for FOB and underlying pathologic conditions. Three of the 10 patients in each group had BAL. No subject had transbronchial biopsy. Demographics for the two study groups are illustrated in Table 1. The low-dose group was older. The groups received nearly identical sedative doses (Table 1). Nine of ten patients in the low-dose group and all ten patients in the high-dose group received meperidol. Eight of the ten patients in the low-dose

Discussion

There is no recommended dosage of lidocaine given by the nebulized route for infants or children. We chose doses of 8 and 4 mg/kg because the standard adult nebulized dose of 4 mL of 4% lidocaine1 would approximate 4 mg/kg and the maximum pediatric squirted dose was suggested to be 8.5 mg/kg.2

Nebulized 2% lidocaine at doses of 8 and 4 mg/kg was shown to be extremely safe in infants and children, with all levels obtained well below the toxic range. Total doses of up to 19.6 mg/kg still did not

Conclusion

Lidocaine is a good local anesthetic, but at toxic levels it can cause seizures, cardiac arrhythmias, cardiac arrest, coma, parasthesia, and death.3 Therefore administration in an efficacious manner with low serum concentrations is beneficial. Although the sample size in this study was small, up to 8 mg/kg nebulized lidocaine administered by face mask was safe, was well-tolerated, and provided adequate topical anesthesia for half the patients.

ACKNOWLEDGMENTS

Dr. I. Argani provided laboratory assistance with the lidocaine levels and Ms. Jane Uman performed statistical analysis.

References (23)

  • ChuSS et al.

    Plasma concentration of lidocaine after endotracheal spray

    Anesth Analg

    (1975)

    • Cited by (0)

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    Copyright © 1997 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.