Abstract
OBJECTIVE:To compare the safety and efficacy of a new spacer-oral nasal mask device with those of the standard needle nozzle spray method for the delivery of aerosolized lidocaine to the upper airway for pre-bronchoscopic anaesthesia in a tertiary care hospital.DESIGN:Single-blind randomized control trial.SETTING:University affiliated tertiary care hospital, ambulatory care bronchoscopy unit.SUBJECTS:Thirty consecutive consenting patients referred for fibreoptic bronchoscopy for various indications.INTERVENTION:Thirty randomized subjects received 150 mg of topical 1% aerosolized lidocaine via standard long needle nosed applicator (group A) or via a new oral/ nasal mask with spacer device (group B). Bronchoscopists, blinded as to the preprocedure topical anaesthetic method used, gave additional topical lidocaine at their discretion.MEASUREMENTS:The study nurse recorded the total dose of lidocaine (mg), timing of the procedure (s), cough frequency expressed as coughs per minute (c/min), vital signs, time for return of gag reflex and patients' subjective comments.RESULTS:Fifteen patients were randomized to each group. The lidocaine dose required for insertion through the vocal cords (mean ± SD) was 282.6±66.3 mg in group A and 203.3±70.6 mg in group B (PÃ0.005). Total lidocaine dose required for the procedure was 330.6±70.2 mg in group A and 256.6±75 mg in group B (PÃ0.01). The mean time for passage of the bronchoscope from mouth entry to through the vocal cords was 82.7±54.5 s in group A and 110.5±64.4 s in group B (P>0.1). The mean total time for the procedure was 699.7±377.5 s in group A and 697.2±409.1 s in group B (not significant). The mean cough frequency was 8.2±6.1 c/min in group A and 7.0±5.7 c/min in group B (not significant). There were no statistically significant differences in heart rate, in return of gag reflex time or in complication rate between the two groups.CONCLUSIONS:A statistically significant reduction in the dose of lidocaine is required to achieve equivalent topical anaesthetic for bronchoscopy with a new mask and spacer device compared with a more conventional method. Since no other variables related to the procedure showed a significant difference, the new method appears to be superior to the previous method.
Highlights
Data analysis: The arithmetic means of the total dose of lidocaine topical anaesthetic required, the mean time to pass through the vocal cords, mean cough frequency and mean total number of coughs were compared between the two groups using unpaired t test analysis
No significant differences were detected between groups with respect to indications for bronchoscopy (Table 2) or to the type of procedures performed (Table 3)
Lidocaine dose: The lidocaine dose required for insertion of the bronchoscope through the vocal cords was 282.7±66.4 mg in group A and 203.3±70.7 mg in group B (P
Summary
To compare the safety and efficacy of a new spacer-oral nasal mask device with those of the standard needle nozzle spray method for the delivery of aerosolized lidocaine to the upper airway for pre-bronchoscopic anaesthesia in a tertiary care hospital. INTERVENTION: Thirty randomized subjects received 150 mg of topical 1% aerosolized lidocaine via standard long needle nosed applicator (group A) or via a new oral/ nasal mask with spacer device (group B). CONCLUSIONS: A statistically significant reduction in the dose of lidocaine is required to achieve equivalent topical anaesthetic for bronchoscopy with a new mask and spacer device compared with a more conventional method. This study compared the dose of lidocaine, the time required and the subject tolerance for a new spacer/mask device versus a conventional spray applicator device in the delivery of aerosolized lidocaine to the oropharynx before bronchoscopy. Data analysis: The arithmetic means of the total dose of lidocaine topical anaesthetic required, the mean time to pass through the vocal cords, mean cough frequency and mean total number of coughs were compared between the two groups using unpaired t test analysis
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