Fibreoptic bronchoscopy without sedation: Is transcricoid injection better than the "spray as you go" technique?

Abstract

Aim:The aim of the study was to compare transcricoid injection with spray as you go technique for diagnostic fibreoptic bronchoscopy, to perform the procedure without sedation and to record any complication or side effects.Methods:Sixty patients belonging to the age group 20–70 years, undergoing diagnostic bronchoscopy over a period of 6 months, were randomly selected and divided into two groups alternatively to receive 3 ml of 4% lignocaine by a single transcricoid puncture (group I) or 2 ml of 4% lignocaine instilled through the bronchoscope on to the vocal cords and further 1 ml of 2% lignocaine into each main bronchus (group II). Additional dose of lignocaine as required was given in both the groups. All patients were given intramuscular atropine 0.6 mg, 20 min before the procedure. Nebulisation with 3 ml of 4% lignocaine was given to all patients. The time from nasal insertion of the bronchoscope to reach the carina was recorded, and the total dose of lignocaine required in both the groups was calculated and compared. The cough episodes during the procedure, systolic blood pressure, and pulse rate were compared before the procedure and 5 min after the procedure in both the groups. A0–10 visual analogue scale (VAS) was used to assess discomfort 30 min after the procedure.Results:The time to reach carina was more in group II (P<0.02), and cough episodes were also more in group II (P<0.05) than in group I. The vitals before the procedure were comparable in both the groups, but 5 min after the procedure the vitals were more stable in group I than in group II, and the total dose of lignocaine required in group II was more than in group I (P<0.001). However, the VAS score was comparable in both the groups.Conclusion:Transcricoid puncture for diagnostic bronchoscopies without sedation was associated with no complication and discomfort and required lesser dose of local anaesthetic with more stable vitals and good conditions for bronchoscopists.

Does “Patient-reported Discomfort” From Bronchoscopy Differ Over Time?

“…14 Another study found no difference in satisfaction between patients having a standard bronchoscopy and those having a TBNA. 18 Our study showed similar results with route of local anesthetic having no influence on comfort scores; however, only a small number of patients in our study received transcricoid injection. It has been established by a number of studies that topical lignocaine through the scope is associated with decreased cough frequency, decreased sedation requirements, and increased patient satisfaction compared with sedation alone.…”

Efficacy of atomised local anaesthetic versus transtracheal topical anaesthesia for awake fibreoptic intubation

“…[ 7 8 9 10 11 ] Being non-invasive, patient acceptability is better with atomisers and nebulisers, but not with ‘spray-as-you-go’ technique. [ 12 ]…”

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

“…A small randomized trial comparing both these methods in no-sedation bronchoscopy found shorter time to reach carina, less cough, and total dose of lignocaine in the cricothyroid group. [159] Visual analog scale (VAS) for patient discomfort was comparable in both groups. Drug administration via cricothyroid injection also found better VAS scores for ease of procedure and cough than spray-as-you go technique in sedation bronchoscopy.…”