FLEXIBLE BRONCHOSCOPY; TRANSCRICOID VERSUS BRONCHOSCOPIC ADMINISTRATION OF LIDOCAINE FOR TOPICAL ANAESTHESIA WITH OR WITHOUT ATROPINE AS PREMEDICATION – A RANDOMIZED STUDY

Abstract

Background. We were interested to study the effectof different ways of administering topical lidocaine and thepossible benefit of using atropine as premedication for flexiblebronchoscopy.Patients and methods. 105 patients were randomised intofour groups. Lidocaine was administered either through thebronchoscope or by transcricoid injection. The use of atropinepremedication was also randomised. The duration of bronchoscopysessions, amount of lidocaine used, symptomes andsigns such as coughing, heart rate and oxygene saturationwere documented. Patients and medical staff graded their perceptionsof the procedure using a four-grade severity scale.Results. The duration of the bronchoscopy was not significantlyprolonged in the group with bronchoscopic lidocaine administrationcompared to the transcricoid group (p = 0.6). The patientswith bronchoscopic lidocaine administration requiredsignificantly more additional lidocaine than in the transcricoidgroup (p = 0.03). No significant difference was found inpatients who received atropine and those without it. Severecoughing recorded by bronchoscopists and nurses was significantlymore frequent in patients without atropine premedication(p = 0.006) but patient did not experience the bronchoscopyto be more unpleasant without atropine.Conclusions. Patients tolerated both variants of topical anaesthesiaequally well but less amount of additional lidocainewas used by transcricoid administration. The use of atropinewas of no benefit, but resulted in more tachycardia events.

Keywords

• flexible bronchoscopy
• topical anaesthesia
• premedication
• atropine