The Comparation Of Combined Anesthesia With Nebulised Lidocaine In Bronchoscopy

Background and objectiveIn 1966, the invention of the flexible bronchoscopy made breakthrough progress in diagnosis of thoracic diseases. Compared with traditional rigid bronchoscope, it significantly increased the scope of vision by being able to detect sub-segmental bronchial structure and reduced the airway stimulation, also the operation can be successfully completed under local anesthesia. With the developments of bronchoscopy technology and exploitation of Argon plasma coagulation(APC), laser and freezing, the application fields of bronchoscopy are no longer limited to the initial diagnostic category, it also shows unique advantages in the treatment of respiratory diseases. The complexity of new technique in procedure and repeated stimulation of airway requires patients’higher coordination during operation, which also asks for higher requirements for preoperative anesthesia. At present, the domestic use of lidocaine aerosol inhalation in more complex operation cannot achieve satisfactory anesthetic effect. Putting patients under general anesthesia not only increases their economic burden but also decreases endoscopic doctor’s work efficiency and medical resources allocation efficiency. Therefore, in order to seek a more applicable and acceptable anesthesia method between local administration and general administration, we compare the effects of simple topical lidocaine aerosol inhalation with combined anesthesia, thus to provide evidences for selecting the best anesthesia method in the practical work.MethodsA total of 60 inpatients who received bronchoscopy operation for the first time in respiratory endoscopy room of Shandong Provincial eastern Hospital from October 2014 to December 2014 were enrolled and randomly divided into 3 groups. Patients in group A were treated with 2% lidocaine aerosol inhalation, group B with lidocaine aerosol inhalation combined with trans-cricothyroid membrane injection while group C with lidocaine aerosol inhalation combined with intravenous midazolam administration. Pulse oxygen saturation (SpO2), heart rate (HR) and mean arterial pressure (MAP) were monitored and recorded at three time points of TO (preoperative resting state), T1 (when bronchoscope inserted glottis) and T2 (during either diagnostic or therapeutic bronchoscopy procedures). Patients’cough, wheezing times were automatically recorded by internal system at T1, T2 points. Anesthetic effects were evaluated by patients’body movement times and additional drug doses during operations. Both operator and patients received visual analog scale (VAS) and severity scale score after bronchoscopy operation, patients were followed up if willing to undergo bronchoscopy the second time to assess the effect of local anesthesia subjectively. Adverse reactions were observed and recorded within 24 hours. Finally, overall anesthesia effects were assessed by professionals and all the data collected were managed and analyzed by SPSS 20.0.ResultsThere was no difference in basic data between the groups(P>0.05).(1) Intraoperative assessments:HR and MAP changed little in patients of group B and C (combined anesthesia), and the hemodynamic parameters were more stable than group A (P<0.01). The patient number of MAP and HR changed more than 30% was significantly more than other two groups (P<0.01). The counts of cough and episodes of wheezing were significantly more in group A at point T1 and T2 (P<0.01). During the whole process, patients’ body movement times and additional drug doses in group B and C were also significantly less than group A (P<0.01), but there was no significant difference between group B and C (P>0.05).(2) Postoperative assessments:Operators’and Patients’VAS and severity scale scores showed a clear preference for the combined anesthesia (group B and C) than group A (P<0.01). Patients’VAS scores showed positive correlations with cough counts and episodes of wheezing (P<0.01). More combined anesthesia group patients expressed willingness to reinspection (P<0.01). Combined anesthesia did not increased risks of adverse reactions occurrence observed in group A (P>0.05), but incidence rate in group C was lower than group B (P<0.05).(3) Assessments of overall anesthesia effects:In the groups of patients with combined anesthesia (group B and C), significant excellent rate was recorded compared with simple nebulised lidocaine local anesthesia (P<0.01). No significant differences were found between the two combined anesthesia groups in terms of the overall effects (P>0.05).Conclusions1. In our study, anesthetic effects of combined anesthesia with nebulized lidocaine is better than simple lidocaine aerosol inhalation method in complex bronchoscopy.2. The anesthetic effects of nebulized lidocaine combined trans-cricothyroid membrane injection showed no significant difference compared with nebulized lidocaine combined with intravenous midazolam administration, while the latter is safer than the former.