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The utility of a multi-orifice epidural catheter when using the “Spray-as-You-Go” technique for topical Airway Anesthesia during Flexible Bronchoscopy, a randomised trial

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Abstract

Background

Lidocaine administered through the working channel of a flexible bronchoscope can provide effective local anesthesia but cannot achieve good distribution in the airway. This study was undertaken to determine whether lidocaine delivered via a multi-orifice epidural catheter (three orifices/openings) is superior to conventional method and if a better distribution and decreased the cough reflex can be achieved.

Methods

The patients (N = 100; 50 in each group) were randomized to receive either topical airway anesthesia by the “spray-as-you-go” technique via conventional application (group C) through the working channel of the bronchoscope or via a triple-orifice epidural catheter (group E). The primary outcome measurement was the cough severity, which was documented using a 4-point scale. Bronchoscopists and nurses assessed the coughing. The visual analogue scale (VAS) score for cough, total consumption of propofol and lidocaine, requirement frequency of propofol and topical anesthesia, PACU retention time, and adverse events were also compared.

Results

There was a significant difference in the median cough severity scores between the two groups (group C: 3 vs. group E: 2, P = 0.004). The median visual analogue scale (VAS) scores for the cough, were significantly higher in group C than those in group E (bronchoscopist: 3 vs. 2 P = 0.002; nurse: 3 vs. 2, P < 0.001). The incidence of cough was significantly higher in group C in the trachea, left and right bronchi. The highest respiratory rate was higher in group C than in group E (P < 0.01). Eight patients in group C and two patients in group E had an oxygen saturation below 90% during flexible bronchoscopy(FB) (P = 0.046). More patients in group C required extra topical anesthesia than in group E (P < 0.001). The total lidocaine consumption was also higher in group C than that in group E (P < 0.001).

Conclusions

Endotracheal topical anesthesia via the multi-orifice epidural catheter (three holes/openings) during flexible bronchoscopy using the “spray-as-you-go” technique was appeared to be superior to the conventional method.

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Availability of data and material

The datasets generated and analysed during the current study are available from the corresponding author on reasonable requests.

References

  1. Wahidi MM, Jain P, Jantz M, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011;140(5):1342–50.

    Article  CAS  Google Scholar 

  2. Du Rand IA, Blaikley J, Booton R, et al. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 2013;68.

  3. Ryu JH, Lee SW, Lee JH, et al. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy. Br J Anaesth. 2012;108(3):503–11.

    Article  CAS  Google Scholar 

  4. Yuan F, Fu H, Yang P, et al. Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study. Exp Ther Med. 2016;12(1):506–12.

    Article  CAS  Google Scholar 

  5. Cox B, Durieux ME, Marcus MA. Toxicity of local anaesthetics. Best Pract Res Clin Anaesthesiol. 2003;17(1):111–36.

    Article  CAS  Google Scholar 

  6. Graham DR, Hay JG, Clague J, et al. Comparison of three different methods used to achieve local anesthesia for fiberoptic bronchoscopy. Chest. 1992;102(3):704–7.

    Article  CAS  Google Scholar 

  7. Sethi N, Tarneja VK, Madhusudanan TP, et al. Local Anaesthesia for Fiberoptic Intubation: A Comparison of Three Techniques. Med J Armed Forces India. 2005;61(1):22–5.

    Article  CAS  Google Scholar 

  8. Dhasmana S, Singh V, Pal US. Nebulisation Versus Spray-as-You-Go Airway Topical Anaesthesia in Patients with Temporomandibular Joint Ankylosis using 2% Lignocaine. J Maxillofac Oral Surg. 2015;14(2):398–402.

    Article  Google Scholar 

  9. Muller T, Cornelissen C, Dreher M. Nebulization versus standard application for topical anaesthesia during flexible bronchoscopy under moderate sedation - a randomized controlled trial. Respir Res. 2018;19(1):227.

    Article  Google Scholar 

  10. Antoniades N, Worsnop C. Topical lidocaine through the bronchoscope reduces cough rate during bronchoscopy. Respirology. 2009;14(6):873–6.

    Article  Google Scholar 

  11. Xue FS, Liu HP, He N, et al. Spray-as-you-go airway topical anesthesia in patients with a difficult airway: a randomized, double-blind comparison of 2% and 4% lidocaine. Anesth Analg. 2009;108(2):536–43.

    Article  Google Scholar 

  12. Chen L, Zhou Y, Cai Y, et al. The ED95 of Nalbuphine in Outpatient-Induced Abortion Compared to Equivalent Sufentanil. Basic Clin Pharmacol Toxicol. 2018;123(2):202–06.

    Article  CAS  Google Scholar 

  13. Aouad MT, Sayyid SS, Zalaket MI, et al. Intravenous lidocaine as adjuvant to sevoflurane anesthesia for endotracheal intubation in children. Anesth Analg. 2003;96(5):1325–7.

    Article  CAS  Google Scholar 

  14. Kar Kurt O, Talay F, Kargi A, et al. [Sedation for fiberoptic bronchoscopy: review of the literature]. Tuberk Toraks. 2015;63(1):42–7.

    Article  Google Scholar 

  15. Stolz D, Chhajed PN, Leuppi JD, et al. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax. 2004;59(9):773–6.

    Article  CAS  Google Scholar 

  16. Williams KA, Barker GL, Harwood RJ, et al. Combined nebulization and spray-as-you-go topical local anaesthesia of the airway. Br J Anaesth. 2005;95(4):549–53.

    Article  CAS  Google Scholar 

  17. Loukides S, Katsoulis K, Tsarpalis K, et al. Serum concentrations of lignocaine before, during and after fiberoptic bronchoscopy. Respiration. 2000;67(1):13–7.

    Article  CAS  Google Scholar 

  18. Langmack EL, Martin RJ, Pak J, et al. Serum lidocaine concentrations in asthmatics undergoing research bronchoscopy. Chest. 2000;117(4):1055–60.

    Article  CAS  Google Scholar 

  19. Ye L, Xiao X, Zhu L. The Comparison of Etomidate and Propofol Anesthesia in Patients Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech. 2017;27(1):1–7.

    Article  Google Scholar 

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Acknowledgements

The authors would like to acknowledge the patients, doctors and nurse involved in this study.

Funding

This work was supported by a grant from Department of Science and Technology of Wenzhou (No Y20190510).

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Authors and Affiliations

Authors

Contributions

LC, FL: Design the study, conduct the study, analyze the data and write the manuscript. YC: Conduct the study, analyze the data and write the manuscript. MY: Performed bronchoscopy. DD, XJ, FL: Conduct the study and record the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fuli Liu.

Ethics declarations

Trial registration

Chinese Clinical Trial Register (Registration number #ChiCTR1800014690; Date of Registration on January 29th,2018)http://www.chictr.org.cn/showproj.aspx?proj=24835.

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University, and registered in the Chinese Clinical Trial Register (ChiCTR1800014690). http://www.chictr.org.cn/showproj.aspx?proj=24835. Before study entry, all subjects reviewed and signed an informed consent document explaining the study procedures and potential risks.

Consent for publication

Not applicable.

Conflict of interest

Yaoyao Cai, Limei Chen, Dongmei Dong, Min Ye, Xiuling Jin and Fuli Liu declare no competing interests.

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Cai, Y., Chen, L., Dong, D. et al. The utility of a multi-orifice epidural catheter when using the “Spray-as-You-Go” technique for topical Airway Anesthesia during Flexible Bronchoscopy, a randomised trial. J Clin Monit Comput 37, 55–62 (2023). https://doi.org/10.1007/s10877-022-00856-8

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  • DOI: https://doi.org/10.1007/s10877-022-00856-8

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