Topical Anesthesia With Lidocaine and the Role of Atropine in Flexible Bronchoscopy

Abstract

Two different methods of topical anesthesia with lidocaine and possible benefits of premedication with atropine were studied in a randomized manner. Patients were randomized into 4 groups: lidocaine for topical anesthesia was administered either through the working channel of the bronchoscope (BC) or by transcricoid (TC) injection with or without premedication with atropine. The duration of bronchoscopic session, amount of lidocaine used, cough, heart rate, and oxygen saturation were documented. Patients, nursing staff, and bronchoscopists graded the cough and salivation during the procedure using a severity scale. The patients who were anesthetized through BC required significant more additional lidocaine than patients in the TC group. The amount of lidocaine required by those who received atropine or placebo was the same. The cough, scored by medical staff as severe, was equally frequent in BC and TC group and was significantly more frequent in patients without atropine premedication and in those whom the bronchoscope was inserted through the mouth. Patients did not recognize any difference between procedure performed with either atropine or placebo premedication. Patients tolerated both variants of topical anesthesia equally well. Bronchoscopy without atropine caused some difficulties to the bronchoscopists because of coughing and salivation, but we did not need to curtail any procedures. In the group of patients who received atropine, more tachycardias were recorded.