Assessment of the Efficacy of Nebulized Local Anaesthesia Using Continuous Positive Airway Pressure during Fibroptic Bronchoscopy

Abstract

Background: The administration of nebulized lidocaine before fiberoptic bronchoscopy (FOB) is preferred than conventional lidocaine spray methods in reducing complications, reducing the need for additional lidocaine doses, and decreasing the incidence of lidocaine adverse effects. The use of nebulized lidocaine through continuous positive airway pressure (CPAP) seems to be superior owing to rapid and deep deposition of the anesthetic agent. The aim of this research is to study if the use of nebulized lidocaine through CPAP is superior to the conventional methods of lidocaine spray before FOB. Patients and Methods: An observational prospective cohort study was performed in the Chest Department at Ain Shams University hospitals on 40 patients subjected to FOB. They were randomly divided into two groups: group A included 20 patients who underwent FOB using nebulized lidocaine through CPAP, and group B included 20 patients who underwent FOB using conventional lidocaine spray. After doing FOB, we noticed the need for additional doses of lidocaine to complete FOB, duration of FOB, easy entry of the FOB, and incidence of complications. Results: Interestingly, patients in group A needed less additional doses of lidocaine spray to complete FOB. Moreover, they had less incidence of coughing and occurrence of gag reflex during FOB, and also less patients’ discomfort, but both duration of FOB and easy entry of the FOB are the same in both groups. Conclusion: Administration of nebulized lidocaine through CPAP before FOB leads to decreased use of lidocaine with less incidence of its adverse effects when compared with conventional method of lidocaine spray, and also it has better patient acceptance than lidocaine spray owing to its unpleasant taste. So it should be recommended for use before FOB on a wider scale.