Catheter Spray of Lidocaine : a Randomized Study of Topical Anesthesia for Flexible Bronchoscopy

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  • Tachihara Motoko
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Ishida Takashi
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Fukuhara Naoko
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Inokoshi Yayoi
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Fukuhara Atsuro
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Saito Kazue
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Ishii Taeko
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Kanazawa Kenya
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine
  • Katsuura Yutaka
    Department of Pulmonary Medicine, Saiseikai Fukushima General Hospital
  • Munakata Mitsuru
    Department of Pulmonary Medicine, Fukushima Medical University School of Medicine

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Abstract

Background. Topical anesthesia is recommended for patients undergoing bronchoscopy. The spray catheter is a device to administer lidocaine in the airway. We performed a prospective, randomized trial to evaluate optimal lidocaine delivery using the spray catheter. Methods. We randomized 88 patients undergoing bronchoscopy without sedation into three groups (catheter A, B, and syringe C, with 23, 34 and 31 patients, respectively). Catheter A patients received two kinds of pre-bronchoscopic lidocaine administration, followed by lidocaine with the spray catheter. Catheter B patients received lidocaine with one pre-bronchoscopic anesthesia, followed by the catheter anesthesia. Syringe C patients received conventional syringe injection after two pre-bronchoscopic anesthesia. Major outcome measures included the frequency of cough, dose and serum concentration of lidocaine, changes in vital signs, and assessment of patient suffering. Results. The lidocaine dose during bronchoscopy in the syringe C group was 312.0±76.0mg (mean±SD), which was significantly higher than that in the catheter A (48.0±6.0mg) and B (50.0±12.0mg, p<0.01) groups. Serum lidocaine concentration in catheter A (1.1±0.3mg/l) and B (1.0±0.1mg/l) groups was significantly lower than that in the syringe C group (2.2±1.2mg/l, p<0.01). There were no statistically significant differences between the three groups in terms of coughing episodes, hemodynamic changes and discomfort questionnaire scores. Conclusion. Safe and efficacious topical anesthesia for awake bronchoscopy can be achieved by catheter spray, with a low dosage and plasma concentration of lidocaine.

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