EMLA® Cream coated on the rigid bronchoscope for tracheobronchial foreign body removal in children

Abstract

Removal of a tracheal or bronchial foreign body is a common emergent surgical procedure in children. The anesthetic management can be challenging. EMLA Cream (EC) has been widely used to provide topical anesthesia. In the present study, we evaluate the efficacy and safety of EC coated on the rigid bronchoscope for tracheobronchial foreign body removal in children undergoing intravenous anesthesia with spontaneous ventilation. The authors conducted a randomized, double-blind, placebo-controlled clinical trial. Thirty patients were randomized to receive either EC or placebo (lubricant ointment) coated on the rigid bronchoscope. Intravenous anesthesia and spontaneous ventilation were performed in all patients. Heart rate, blood pressure, pulse oxygen saturation (SpO(2)) and frequency and degree of breath holding were recorded. After surgery, the bronchoscopist rated overall surgical manipulation as excellent, fair, and poor. The durations of postoperative care were also recorded. Episodes of oxygen desaturation (SpO(2) < 90%) occurred in 3/15 (20%) patients in the EC group and in 9/15 (60%) patients in the control group (P < .05). Occurrences and degrees of breath holding were less in the EC group than that in the control group (P < .05). Ranks of surgical manipulation were excellent in 80% of patients in the EC group versus 13% of patients in the control group (P < .05). The durations of postoperative care were shorter in the EC group than that in the control group (P < .05). EC coated on the rigid bronchoscope combined with intravenous anesthesia could provide more efficacious and safer anesthesia for tracheobronchial foreign body removal in children under spontaneous ventilation.