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 effect
of different ways of administering topical lidocaine and the
possible benefit of using atropine as premedication for flexible
bronchoscopy.
Patients and methods. 105 patients were randomised into
four groups. Lidocaine was administered either through the
bronchoscope or by transcricoid injection. The use of atropine
premedication was also randomised. The duration of bronchoscopy
sessions, amount of lidocaine used, symptomes and
signs such as coughing, heart rate and oxygene saturation
were documented. Patients and medical staff graded their perceptions
of the procedure using a four-grade severity scale.
Results. The duration of the bronchoscopy was not significantly
prolonged in the group with bronchoscopic lidocaine administration
compared to the transcricoid group (p = 0.6). The patients
with bronchoscopic lidocaine administration required
significantly more additional lidocaine than in the transcricoid
group (p = 0.03). No significant difference was found in
patients who received atropine and those without it. Severe
coughing recorded by bronchoscopists and nurses was significantly
more frequent in patients without atropine premedication
(p = 0.006) but patient did not experience the bronchoscopy
to be more unpleasant without atropine.
Conclusions. Patients tolerated both variants of topical anaesthesia
equally well but less amount of additional lidocaine
was used by transcricoid administration. The use of atropine
was of no benefit, but resulted in more tachycardia events.
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