Bronchoscopy in Healthy Volunteers

Abstract

Abstract Healthy volunteers undergo flexible bronchoscopy in our laboratory during investigation into the mechanisms of lung injury after inhalational exposure to environmental agents, including ozone, nitrogen oxides, acidic aerosols, sulfur dioxide, air pollution particles, and in the absence of any exposure to obtain normal respiratory tract cells. One or more bronchoscopy-associated methods (bronchoalveolar lavage, brush biopsy, and endobronchial forceps biopsy) are included in the procedure. An absence of serious complications resulting from the procedure is clearly required for such studies to be pursued. However, the first death of a healthy volunteer undergoing investigative bronchoscopy has been reported recently in the public press and attributed to lidocaine toxicity. This impelled us to review our experience in 736 healthy volunteers. Significant complications have occurred in six of these subjects (0.8%) including fever (n = 5), pneumonia (n = 4), and chest pain (n = 1). We elected to continue our present protocol. With an emphasis on eliminating complications resulting from anesthesia, we suggest that the total dose of lidocaine instilled through the bronchoscope during the procedure not exceed 300 mg and that no sedative or narcotic be used. In addition, we recommend that no endotracheal tube be used and the introduction of the bronchoscope be transnasal. In our experience, this approach reduces the requirement for topical anesthesia compared with using an endotracheal tube and the transoral route.