Is Nebulized Lidocaine Adequate Topical Anesthesia for Diagnostic Transnasal Tracheoscopy?. (July 2015)

• Record Type: Journal Article
• Authors: Sharma, Giriraj K.; Verma, Sunil P.
• Is Part Of: Annals of otology, rhinology & laryngology. Volume 124:Number 7(2015:Jul.)
• Page Start: 545
• Page End: 549
• Publication Date: 2015-07
• Subjects: transnasal tracheoscopy -- laryngeal anesthesia -- laryngeal drip -- laryngeal gargle; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0003489415570929
• Languages: English
• ISSNs: 0003-4894

Abstract

Objectives: To evaluate if nebulized 4% lidocaine alone provides adequate laryngopharyngeal anesthesia for office-based diagnostic transnasal tracheoscopy (TNT). Methods: A retrospective chart review (January 2011 to June 2014) and a prospective case series (July 2014 to December 2014) of patients who underwent diagnostic TNT were performed at a university voice and swallowing center. TNT cases were categorized by method of topical laryngopharyngeal anesthesia: nebulized 4% lidocaine and 4% lidocaine drip (phase I) and nebulized 4% lidocaine only (phase II). Results: TNT was performed a total of 59 times on 38 patients. Eleven (69%) of 16 phase I TNT procedures involved significant patient discomfort and severe cough following the lidocaine drip. Forty-two (98%) of 43 phase II TNT procedures were completed comfortably; 1 case required additional anesthesia by lidocaine drip. Retrospectively, 100% (n = 8) of patients who underwent both phase I and phase II TNTs were noted to prefer anesthesia with nebulizer alone. In a prospective case series of 14 phase II TNT cases, 6 (86%) of 7 patients who previously underwent phase I TNT reported preference for anesthesia with nebulizer alone. Conclusions: Nebulized lidocaine appears to provide sufficient laryngopharyngeal anesthesia for diagnostic TNT. It is preferred by patients over laryngeal drip.