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.
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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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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.
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Chinese Clinical Trial Register (Registration number #ChiCTR1800014690; Date of Registration on January 29th,2018)http://www.chictr.org.cn/showproj.aspx?proj=24835.
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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.
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Yaoyao Cai, Limei Chen, Dongmei Dong, Min Ye, **uling ** 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