Chest
BronchoscopyNebulized Lidocaine for Flexible Bronchoscopy: A Randomized, Double-Blind, Placebo-Controlled Trial
Section snippets
Patients
The study has been approved by the institutional ethical committee. After obtaining written informed consent, 150 consecutive patients undergoing diagnostic flexible bronchoscopy were prospectively randomized utilizing a computer system to receive either nebulized 4% lidocaine or placebo in a double-blind fashion. Intubated patients, those receiving propofol (eg, IV drug abuse), and patients requiring endobronchial ultrasound examination were not included in this trial.
Study Design
Bronchoscopies were
Results
Patient characteristics are presented in Table 1. All examinations could be completed as planned. There were no significant differences in age, gender, and indication for bronchoscopy between both groups. Distribution of different invasive bronchoscopic procedures performed were also similar in both groups (Table 2). The most common procedures were BAL in 77 cases (51%), followed by bronchial washings in 63 cases (42%), transbronchial biopsy in 40 cases (27%), and transbronchial needle
Discussion
This study demonstrates no additional benefit of nebulized lidocaine in reducing the total dose of topical anesthetic administered for flexible bronchoscopy in patients receiving combined sedation with midazolam and hydrocodone. Indeed, patients treated with nebulized lidocaine received overall greater amounts of lidocaine than the placebo group. Furthermore, the administration of aerosolized lidocaine prior to bronchoscopy did not significantly improve patient comfort or prevent cough.
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Cited by (65)
Taking the Air Out of Nebulized Lidocaine
2020, ChestA Randomized Trial of Nebulized Lignocaine, Lignocaine Spray, or Their Combination for Topical Anesthesia During Diagnostic Flexible Bronchoscopy
2020, ChestCitation Excerpt :Early nonrandomized studies on the use of nebulized lignocaine during bronchoscopy found it to be an effective and acceptable means of delivering topical anesthesia to the respiratory tract.23,24 What, then, is the possible reason for the apparent lack of efficacy of nebulized lignocaine in previous randomized trials9-15 and the current study (despite a similar dose administered by nebulization and spray)? Nebulized lignocaine spreads extensively in the form of an aerosol over the surface of the mucosa of the entire respiratory tract (nose, mouth, pharynx, vocal cords, trachea, and bronchi).11
Sedation in Bronchoscopy: A Review
2018, Clinics in Chest MedicineCitation Excerpt :Nebulized lidocaine is another option for analgesia delivery, although supporting evidence in this area remains less convincing. One study found no difference in cough frequency or patient discomfort when comparing nebulized lidocaine to the placebo, nebulized saline.14 Notably, the onset of action of nebulized lidocaine is approximately 15 to 20 minutes, whereas direct drip lidocaine typically works within seconds of administration.
The influence of propofol, remifentanil and lidocaine on the tone of human bronchial smooth muscle
2013, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :The drug concentrations in the isolated organ bath were equivalent to the plasma-site concentrations set up for bronchoscopies performed at the Division of Thoracic Surgery, Sant'Andrea Hospital (Rome, Italy) by using the open-source software StanPump (Stanford, CA, USA) for TCI [19–22]. Since the topical instillation/nebulisation of a local anaesthetic along the respiratory tree is a usual practice during bronchoscopy, we also evaluated the influence of lidocaine, ranging from 1 μg ml−1 to 1 mg ml−1, on the responsiveness of human bronchi to EFS [6,7]. In further experiments, the isolated bronchi were pre-treated for 45 min with the selective inhibitor of inducible nitric oxide (NO) synthase (iNOS), aminoguanidine (100 μmol) and then treated with propofol [23].
Contribution of budesonide nebulization in bronchoscopy
2023, Research Square
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