Karan Madan1, Saurabh Mittal2, Nishkarsh Gupta3, Shiba Kalyan Biswal2, Pawan Tiwari2, Vijay Hadda2, Anant Mohan2, Randeep Guleria2. 1. Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India, drkaranmadan@gmail.com. 2. Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India. 3. Department of Onco-Anesthesia and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Abstract
BACKGROUND: Comparative characteristics of the cricothyroid injection and spray-as-you-go methods for lidocaine administration during diagnostic flexible bronchoscopy are not clear. OBJECTIVES: Co-primary outcomes were comparison of cough count from bronchoscope introduction until reaching carina and operator-rated overall procedure satisfaction on a Visual Analogue Scale (VAS) between groups. Secondary outcomes were cumulative lidocaine dose, procedure duration, assistant-rated cough, willingness to return for repeat procedure, and procedural complications between groups. METHODS: Consecutive subjects were randomized (1:1) to either the cricothyroid or the spray-as-you-go method for topical anesthesia to the vocal cords and trachea. All received nasal 2% lidocaine gel and pharyngeal 10% lidocaine spray. RESULTS: A total of 500 subjects were randomized, and 495 subjects were analyzed (248 cricothyroid and 247 spray-as-you-go). Cough count until reaching carina (median [range]) was significantly lower (cricothyroid, 1 [0-10], and spray-as-you-go, 4 [0-30], p < 0.0001) and operator-rated overall procedure satisfaction, VAS (mean ± standard deviation) (cricothyroid, 7.86 ± 1.39 and spray-as-you-go, 6.86 ± 1.59, p < 0.0001) significantly greater in the cricothyroid group. Patient willingness to return for repeat procedure was greater (87.1 vs. 70.5%, p < 0.001)) and cumulative lidocaine dose significantly lower (305.08 ± 13.40 vs. 322.18 ± 10.67 mg, p < 0.001) in the cricothyroid group. Minor complications occurred in 6 patients in the cricothyroid group and 9 patients in the spray-as-you-go group. CONCLUSION:Cricothyroid lidocaine administration is associated with less cough and superior operator-rated procedure satisfaction during bronchoscopy at a lower cumulative lidocaine dose.
RCT Entities:
BACKGROUND: Comparative characteristics of the cricothyroid injection and spray-as-you-go methods for lidocaine administration during diagnostic flexible bronchoscopy are not clear. OBJECTIVES: Co-primary outcomes were comparison of cough count from bronchoscope introduction until reaching carina and operator-rated overall procedure satisfaction on a Visual Analogue Scale (VAS) between groups. Secondary outcomes were cumulative lidocaine dose, procedure duration, assistant-rated cough, willingness to return for repeat procedure, and procedural complications between groups. METHODS: Consecutive subjects were randomized (1:1) to either the cricothyroid or the spray-as-you-go method for topical anesthesia to the vocal cords and trachea. All received nasal 2% lidocaine gel and pharyngeal 10% lidocaine spray. RESULTS: A total of 500 subjects were randomized, and 495 subjects were analyzed (248 cricothyroid and 247 spray-as-you-go). Cough count until reaching carina (median [range]) was significantly lower (cricothyroid, 1 [0-10], and spray-as-you-go, 4 [0-30], p < 0.0001) and operator-rated overall procedure satisfaction, VAS (mean ± standard deviation) (cricothyroid, 7.86 ± 1.39 and spray-as-you-go, 6.86 ± 1.59, p < 0.0001) significantly greater in the cricothyroid group. Patient willingness to return for repeat procedure was greater (87.1 vs. 70.5%, p < 0.001)) and cumulative lidocaine dose significantly lower (305.08 ± 13.40 vs. 322.18 ± 10.67 mg, p < 0.001) in the cricothyroid group. Minor complications occurred in 6 patients in the cricothyroid group and 9 patients in the spray-as-you-go group. CONCLUSION:Cricothyroid lidocaine administration is associated with less cough and superior operator-rated procedure satisfaction during bronchoscopy at a lower cumulative lidocaine dose.
Authors: Kavitha Venkatnarayan; Uma Devaraj; Uma Maheswari Krishnaswamy; Priya Ramachandran; Tinku Thomas; George D'Souza Journal: Lung India Date: 2020 Sep-Oct