Author(s): Koushik Muthu Raja Mathivanan1, Rajashree Vijayakumar2, Kasthuri Mahendran3, Dhanasekar Thangaswamy4, Rajagopalan Balakrishnan5
Anaesthesia for bronchoscopy poses unique challenges for the pulmonologist. By definition, bronchoscopy is an endoscopic technique to visualise the inside of the airways, it is a pivotal diagnostic and therapeutic tool in Pulmonary Medicine. Rigid bronchoscopy is usually done for diagnosis and treatment of intra and/or extra luminal obstruction in the airway for adults and children. With the development of fibreoptic and advanced electronic technology, the flexible bronchoscope has replaced the rigid bronchoscope for most diagnostic and some therapeutic indications. Rigid bronchoscopy requires general anaesthesia, however, flexible bronchoscopy can be performed with conscious sedation supplemented with local anaesthesia. The aim of the study is to1. Assess the effect of local anaesthesia on cough suppression during flexible bronchoscopy, when given by two different methods. 2. Compare the degree of cough and patient comfort while using “10% lignocaine spray + 2% lignocaine as you go technique, versus 4% lignocaine nebulisation + 2% lignocaine as you go technique.”
MATERIALS AND METHODS
It is a prospective study done on 50 consecutive patients undergoing diagnostic flexible bronchoscopy from December 2016 to February 2017. The study groups were assembled by block randomisation technique to receive lignocaine (local anaesthesia) as either “as you go” and “spray” or “as you go” and “nebulisation”. Institutional Ethics Committee clearance was obtained prior to commencement of the study.
The study involving 50 patients and statistical analysis illustrated that in 2% lignocaine as you go + 10% lignocaine spray “no cough” and “mild cough” is 18 out of sample 25, which is 72%. Hence, “10% lignocaine spray + 2% lignocaine as you go” is better than “4% lignocaine nebulisation + 2% lignocaine as you go” technique. There was no significant arrhythmias in any of the patients. The dose of lidocaine is 400 to 500 mg (8 mg/kg), 1% = 10 mg/mL, hence 2% in a 50 kg man = maximum of 20 mL. Therefore, medication with “10% lignocaine spray + 2% lignocaine as you go” technique is safer and comfortable for all bronchoscopic patients.
In our study, the combination of “10% lignocaine spray in posterior pharyngeal wall and 2% lignocaine as you go” markedly reduces cough during flexible bronchoscopy without causing significant desaturation especially when invasive diagnostic procedures are performed.